心电图QRS波群形态缺血分级与ST段抬高型心肌梗死患者严重心律失常及靶血管的关系研究  

Relationship of Ischemic Grading of QRS Complex Morphology of ECG with Severe Arrhythmia and Target Vessel in Patients with ST-segment Elevation Myocardial Infarction

作　　者：饶太萍 李春梅 李俊[1] 叶芳媛 RAO Taiping;LI Chunmei;LI Jun;YE Fangyuan(Special Examination Department,the First People's Hospital of Neijiang,Neijiang 641000,China)

机构地区：[1]四川省内江市第一人民医院特检科,641000

出　　处：《实用心脑肺血管病杂志》2021年第2期32-37,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：四川省科学技术厅科技计划项目(2018SZ13725)。

摘　　要：背景目前,心电图QRS波群形态缺血分级与ST段抬高型心肌梗死(STEMI)患者严重心律失常发生风险及靶血管的关系尚未完全明确。目的探讨心电图QRS波群形态缺血分级与STEMI患者严重心律失常及靶血管的关系。方法选取2016年7月—2019年11月内江市第一人民医院收治的126例STEMI患者作为研究对象,按照入院时心电图QRS波群形态进行心肌缺血分级,其中Ⅱ级缺血组(n=75)、Ⅲ级缺血组(n=51)。两组患者均于发病12 h内实施溶栓治疗。比较两组患者一般资料,入院时及溶栓2 h后心电图ST段情况,入院24 h内N末端脑钠肽前体(NT-proBNP)峰值、心肌肌钙蛋白I(cTnI)峰值、肌酸激酶同工酶(CK-MB)峰值,住院期间严重心律失常发生情况及靶血管。STEMI患者发生严重心律失常的影响因素分析采用多因素Logistic回归分析。结果Ⅲ级缺血组患者入院时、溶栓2 h后∑ST大于Ⅱ级缺血组,溶栓2 h后ST段回降≥50%者所占比例低于Ⅱ级缺血组(P<0.05)。Ⅲ级缺血组患者入院24 h内NT-proBNP峰值、cTnI峰值、CK-MB峰值均高于Ⅱ级缺血组(P<0.05)。Ⅲ级缺血组患者住院期间严重心律失常发生率为27.4%(14/51),高于Ⅱ级缺血组的12.0%(9/75)(P<0.05)。Ⅲ级缺血组患者右冠状动脉主干、回旋支病变发生率低于Ⅱ级缺血组,左主干、左前降支病变发生率高于Ⅱ级缺血组(P<0.05)。多因素Logistic回归分析结果显示,发病至溶栓时间[OR=4.092,95%CI(1.575,10.628)]、入院时∑ST[OR=5.563,95%CI(1.972,15.687)]、溶栓2 h后∑ST[OR=4.081,95%CI(1.934,9.032)]、溶栓2 h后ST段回降≥50%[OR=0.411,95%CI(0.265,0.666)]、入院24 h内NT-proBNP峰值[OR=5.293,95%CI(1.718,16.298)]、入院24 h内cTnI峰值[OR=4.890,95%CI(2.028,11.788)]、入院24 h内CK-MB峰值[OR=5.882,95%CI(2.029,17.052)]和心电图QRS波群形态缺血分级[OR=2.560,95%CI(1.307,5.014)]是STEMI患者发生严重心律失常的独立影响因素(P<0.05)。结论心电图QRS波群形态缺血分Background At present,the relationship of ischemic grading of QRS complex morphology of ECG with severe arrhythmia and target vessel in patients with ST-segment elevation myocardial infarction(STEMI)has not been fully defined.Objective To investigate the relationship of ischemic grading of QRS complex morphology of eletrocadiogram(ECG)with severe arrhythmia and target vessel in patients with STEMI.Methods From July 2016 to November 2019,a total of 126 patients with STEMI in the First People's Hospital of Neijiang were selected as the research objects.The myocardial ischemia classification was adopted according to the QRS complex morphology of the ECG at admission,and they were divided into gradeⅡischemia group(n=75)and gradeⅢischemia group(n=51).Both groups received thrombolytic therapy within 12 hours of onset.The general information,ST segment of ECG at admission and 2 hours after thrombolysis,peak values of N-terminal pro-brain natriuretic peptide precursor(NT-proBNP),cardiac troponin I(cTnI)and creatine kinase isoenzyme(CKMB)within 24 hours after admission,occurrence of severe arrhythmia during hospitalization and target vessel were compared between the two groups.Multivariate Logistic regression analysis was used to explore the influencing factors of severe arrhythmia in STEMI patients.Results TheΣST at admission and 2 hours after thrombolysis in the gradeⅢischemia group were higher than those in the gradeⅡischemia group,while the proportion of patients with ST segment depression≥50%at 2 hours after thrombolysis was lower than that in gradeⅡischemia group(P<0.05).The peak values of NT-proBNP,cTnI and CK-MB within 24 hours after admission in the gradeⅢischemia group were higher than those in the gradeⅡischemia group(P<0.05).The incidence of severe arrhythmia in gradeⅢischemia group was 27.4%(14/51),which was higher than 12.0%(9/75)in gradeⅡischemia group(P<0.05).The incidence of lesions in right main coronary artery and circumflex branch in gradeⅢischemia group were lower than those in

关 键 词：心肌梗死 ST段抬高 心律失常 心电描计术 缺血分级 靶血管 

分 类 号：R542.22[医药卫生—心血管疾病] R541.7[医药卫生—内科学]