下壁导联室性早搏R/S波比值与慢性心力衰竭预后的关系  

Relationship between R/S ratio of ventricular premature contractions in inferior leads and prognosis of chronic heart failure

作　　者：曾春梅[1] 刘明[1] 曾书燚[1] 罗宇萍[1] 钟欣静 ZENG Chun-mei;LIU Ming;ZENG Shu-yi;LUO Yu-ping;ZHONG Xin-jing(Department of Cardiovascular,The First People's Hospital of Yulin,Yulin,Guangxi 537000,China)

机构地区：[1]玉林市第一人民医院心血管内科,广西玉林537000

出　　处：《中国临床研究》2021年第7期890-894,共5页Chinese Journal of Clinical Research

基　　金：玉林市科学研究与技术开发项目(玉市科20171611)。

摘　　要：目的分析慢性充血性心力衰竭(CHF)患者室性早搏的特点,了解下壁导联室性早搏R/S波比值与CHF预后的关系。方法选取2017年7月至2018年9月在心血管内科住院的CHF经治疗后病情稳定的患者作为研究对象。170例患者完善24 h动态心电图检查,根据下壁导联室性早搏的R/S波比值分为R/S≥1组(n=85)和R/S<1组(n=85),随访1年,比较两组的主要终点事件(死亡)及次要终点事件[心力衰竭(心衰)再住院]的情况。结果入组患者中共54例(31.76%)记录到至少1次非持续性室性心动过速(NSVT),与R/S≥1组相比,R/S<1组NSVT发生率更高(40.00%vs 23.53%,χ^(2)=5.319,P=0.021)。出现主要终点事件的患者共31例(18.24%),进展性心衰死亡16例(51.61%),猝死8例(25.81%),原因不详7例(22.58%)。R/S≥1组死亡率低于R/S<1组(11.76%vs 24.71%,χ^(2)=4.774,P=0.029),患者生存期长于R/S<1组[(7.60±3.60)个月vs(5.62±2.89)个月,t=3.954,P=0.001],差异有统计学意义。Logistic回归分析表明,R/S波比值<1是死亡的独立危险因素[OR=0.306,95%CI(0.122~0.768),P=0.012],但在校正成对室早及NSVT后差异无统计学意义[OR=0.422,95%CI(0.174~1.024),P=0.057]。在次要终点事件方面,R/S≥1组心衰再住院率低于R/S<1组(34.12%vs 54.12%,χ^(2)=6.895,P=0.009),首次心衰至再住院间隔时间长于R/S<1组(P=0.041)。Logistic回归分析表明,R/S波比值<1是心衰再住院的独立危险因素[OR=2.900,95%CI(1.434~5.865),P=0.003],且校正成对室早及NSVT后差异仍有统计学意义[OR=2.386,95%CI(1.251~4.551),P=0.008]。结论 CHF患者室性心律失常发生率明显增高,下壁导联室性早搏R/S波比值与其预后具有相关性,R/S<1或为其不良预后的预测因素,但需要综合考虑成对室性早搏及NSVT的影响。Objective To analyze the characteristics of premature ventricular contractions(PVCs) and study the relationship between R/S ratio of PVCs in inferior leads and prognosis in patients with chronic heart failure(CHF).Methods A total of 170 stable CHF inpatients from July 2017 to September 2018 were selected as the research objects.After taking 24 hours dynamic electrocardiogram examination(DCG),the patients were divided into R/S≥1 group and R/S<1 group(n=85,each) according to R/S ratio.The primary end point(death) and the secondary end point [heart failure(HF) readmission] were compared between two groups during 1 year of follow-up.Results There were 54 patients(31.76%) with at least one episode of non-sustained ventricular tachycardia(NSVT).The incidence of NSVT in R/S < 1 group was significantly higher than that in R/S≥1 group(40.00% vs 23.53%,χ^(2)=5.319,P=0.021).The primary end point events occurred in 31 cases(18.24%),including 16 cases(51.61%) of progressive HF death,8 cases(25.81%) of sudden death,and 7 cases(22.58%) with unknown cause.The mortality rate in R/S≥1 group was lower than that in R/S<1 group(11.76% vs 24.71%,χ^(2)=4.774,P=0.029),the survival time in R/S≥1 group was longer than that in R/S<1 group [(7.60±3.60) months vs(5.62±2.89) months,t=3.954,P=0.001].Logistic regression analysis showed that lower R/S ratio was an independent risk factor for death [OR=0.306,95%CI(0.122-0.768),P=0.012],but there was no significant difference after adjustment for paired ventricular premature beats and NSVT[OR=0.422,95%CI(0.174-1.024),P=0.057].In terms of secondary end point,the rate of HF readmission in R/S≥1 group was significantly lower than that in R/S<1 group(34.12% vs 54.12%,χ^(2)=6.895,P=0.009),and the time from first HF to readmission was longer than that in R/S<1 group(P=0.041).Logistic regression analysis showed that lower R/S ratio was an independent risk factor for HF readmission[OR=2.900,95%CI(1.434-5.865),P=0.003],and yet there was a significant difference after adjustment for paired ve

关 键 词：慢性心力衰竭 室性早搏 R/S波比值 非持续性室性心动过速 预后 

分 类 号：R541.6[医药卫生—心血管疾病]