Selvester QRS积分对急性心肌梗死PCI术后心肌瘢痕负荷评估及中期随访的临床价值  

Clinical value of Selvester QRS score in evaluating myocardial scar load and mid-term follow-up for patients with acute myocardial infarction after percutaneous coronary intervention

作　　者：龚觉晓[1] 沈竹阳 季佳文 秦鹏[1] 王新东[1] 高昕[1] 阎芹[1] 陈晓栋[1] Gong Jue-xiao;Shen Zhu-yang;Ji Jia-wen;Qin Peng;Wang Xin-dong;Gao Xin;Yan Qin;Chen Xiao-dong(Department of Cardiology, Nanjing Integrated Traditional Chinese and Western Medicine Hospital, Jiangsu Institute of Traditional Chinese Medicine, Nanjing Jiangsu 210028;Department of Cardiology, Tongzhou District Chinese Medicine Hospital, Nantong Jiangsu 226300, China)

机构地区：[1]南京中医药大学附属中西医结合医院心内科,江苏省中医药研究院,江苏南京210028 [2]通州区中医院心内科,江苏南通226300

出　　处：《实用心电学杂志》2018年第6期392-396,共5页Journal of Practical Electrocardiology

基　　金：南京市科委项目(201803065)

摘　　要：目的探讨Selvester QRS积分对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)急诊经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后心肌瘢痕负荷的评估及中期随访的临床价值,并研究其急性期和随访期积分变化的影响因素。方法连续纳入急性STEMI行急诊PCI术的患者55例,将完成随访的48例设为总研究组、前壁心梗组和下壁心梗组,分别于术后1周、1个月、3个月和6个月进行随访,收集其临床资料,记录18导联心电图,并进行Selvester QRS积分评估。结果前壁心梗组的Selvester QRS积分在术后1周、1个月、3个月呈逐步下降趋势,而术后3个月和6个月的积分比较,差异无统计学意义;下壁心梗组的积分在各个随访时间节点比较,差异均无统计学意义。前壁心梗组的积分变化幅度与罪犯血管开通时间相关(r=0. 849,P=0. 006)。结论 Selvester QRS积分可有效评估急性STEMI急诊PCI后的心肌瘢痕负荷。对急性前壁心梗的积分评估建议在术后3个月进行,而急性下壁心肌梗死则无明确的评估时间要求。Objective To explore the clinical value of Selvester QRS score in evaluating the myocardial scar load and mid-term follow-up for the patients with acute ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI),and to investigate the influencing factors of score variation at acute stage and during the follow-up.Methods Fifty-five acute STEMI patients who had undergone emergency PCI were consecutively enrolled in our study.Among them,48 patients with follow-up completed were classified into general research group,anterior myocardial infarction group and inferior myocardial infarction group,and they were followed up separately 1 week,1 month,3 months and 6 months after PCI.Clinical data were collected and 18-lead ECG was recorded.Selvester QRS score evaluation was synchronously performed.Results In the anterior myocardial infarction group,Selvester QRS score gradually decreased 1 week,1 month and 3 months after PCI while the score did not significantly vary from 3 months to 6 months postoperatively.By making paired comparison among Selvester QRS scores at different time nodes of follow-up,we found there was no statistically significant difference in the inferior myocardial infarction group.The amplitude of score variation in the anterior myocardial infarction group was related to the opening time of culprit vessel(r=0.849,P=0.006).Conclusion Selvester QRS score proves to be effective for evaluating the myocardial scar load among the acute STEMI patients after emergency PCI.For patients with acute anterior myocardial infarction,it is suggested to make the score evaluation 3 months after PCI while no definite assessment time is required for the cases with acute inferior myocardial infarction.

关 键 词：心电图 ST段抬高型心肌梗死 急诊经皮冠状动脉介入治疗 Selvester QRS积分 

分 类 号：R542.22[医药卫生—心血管疾病]