心脏手术患者体外循环心脏复跳后心电图Ⅱ导联QRS波演变情况及其临床意义  

Evolution and Clinical Significance of QRS Wave of ECG LeadⅡafter Cardiac Rebeating in Cardiopulmonary Bypass of Patients Undergoing Cardiac Surgery

作　　者：张军 赵雪屏 高文燕 ZHANG Jun;ZHAO Xueping;GAO Wenyan(Department of Cardiopulmonary Bypass,Shanxi Cardiovascular Hospital,Taiyuan 030024,China)

机构地区：[1]山西省心血管病医院体外循环科,山西省太原市030024

出　　处：《实用心脑肺血管病杂志》2021年第12期107-111,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：背景体外循环(CPB)是替代心脏手术患者术中心肺功能的重要方式,准确预测CPB心脏复跳患者心功能恢复情况至关重要。心脏复跳后心电图QRS波演变或与心肌细胞功能恢复有一定关系,目前国内外尚无研究具体分析QRS波演变情况对心肌功能的预测价值。目的 探讨心脏手术患者CPB心脏复跳后心电图Ⅱ导联QRS波演变情况及其临床意义。方法 选取2019年1月至2020年8月山西省心血管病医院心脏外科收治的CPB心脏手术患者180例,其中瓣膜置换术108例,瓣膜成形术47例,冠状动脉旁路移植术(CABG)15例,瓣膜置换术联合CABG10例。观察患者CPB心脏复跳后心电图Ⅱ导联QRS波演变情况,记录术中主动脉阻断时间。比较不同手术方式患者CPB心脏复跳后15、30、> 30 min心电图Ⅱ导联QRS波演变发生率;比较CPB心脏复跳心电图Ⅱ导联QRS波发生演变与未发生演变患者的术中主动脉阻断时间;比较QRS波时限<110 ms与QRS波时限≥110 ms患者心功能指标〔纽约心脏病协会(NYHA)分级、左心室射血分数(LVEF)、血清N末端脑钠肽前体(NT-proBNP)水平〕。采用Spearman秩相关分析探讨心脏手术患者CPB心脏复跳后心电图Ⅱ导联QRS波时限与心功能指标的相关性。结果 术前,心脏手术患者心电图Ⅱ导联QRS波表现为主波向下,呈rS型。143例(79.44%)患者自CPB心脏复跳即刻自主心律和呼吸频率逐渐恢复正常,QRS波呈Rs型伴增宽;CPB心脏复跳后15 min,QRS波呈rS型伴S波增宽;CPB心脏复跳后30 min,QRS波呈Rs型,时程恢复正常;CPB心脏复跳后35 min,QRS波呈Rs型,时程缩短,而后逐渐恢复至术前形态。不同手术方式患者CPB心脏复跳后15、30、> 30 min心电图Ⅱ导联QRS波演变发生率比较,差异无统计学意义(P>0.05)。143例CPB心脏复跳后心电图Ⅱ导联QRS波发生演变者的主动脉阻断时间短于37例CPB心脏复跳后心电图Ⅱ导联QRS波未发生演变者(P <0.001)。180例患者中,QRS�Backgroud Cardiopulmonary bypass(CPB)is an important way to replace the pulmonary function of patients undergoing cardiac surgery,and it is very important to accurately predict the recovery of cardiac function of patients with cardiac rebeating in CPB.The evolution of QRS wave in ECG after cardiac rebeating may be related to the recovery of myocardial cell function.At present,there is no study to specifically analyze the predictive value of QRS wave evolutionon for myocardial functionat at home and abroad.Objective To discuss the evolution and clinical significance of QRS wave of ECG leadⅡafter cardiac rebeating in CPB of patients undergoing cardiac surgery.Methods A total of 180 patients who underwent cardiac surgery under CPB in Cardiac Surgery Department,Shanxi Cardiovascular Hospital from January 2019 to August 2020 were selected,among them,there were 108 cases of valve replacement,47 cases of valvuloplasty,15 cases of coronary artery bypass grafting(CABG)and 10 cases of valve replacement combined with CABG.The evolution of QRS wave in leadⅡof ECG after cardiac rebeating in CPB was observed,and the intraoperative aortic occlusion time was recorded.Incidence of QRS wave evolution in leadⅡof ECG at 15,30 and>30 min after cardiac rebeating in CPB were compared in patients with different operation methods;intraoperative aortic occlusion time was compared between the patients with QRS wave evolution or not in ECG leadⅡof ECG after cardiac rebeating in CPB;and the cardiac function indexes[New York Heart Association(NYHA)grade,left ventricular ejection fraction(LVEF),serum N-terminal pro-brain natriuretic peptide(NT-proBNP)level]were compared between patients with QRS wave duration<110 ms and patients with QRS wave duration≥110 ms.Spearman rank correlation analysis was used to explore the correlation between QRS wave duration in leadⅡof ECG and cardiac function indexes after cardiac rebeating in CPB of patients undergoing cardiac surgery.Results Before operation,the QRS wave in leadⅡof ECG of patients

关 键 词：心脏外科手术 体外循环 心脏复跳 心电图 QRS波 心肌功能 

分 类 号：R654.2[医药卫生—外科学]