心电图aVR导联ST段变化对非ST段抬高型急性冠脉综合征患者的影响  

Effect of ST segment changes in lead aVR of patients with non-ST- segment elevation acute coronary syndrome

作　　者：秦园生 唐秀娥 QIN Yuansheng;TANG Xiu′e(Department of Cardiology,the First Affiliated of Dalian Medical University,Liaoning Province,Dalian116000,China;Department of Cardiology,Dalian Jiche Hospital,Liaoning Province,Dalian116000,China)

机构地区：[1]大连医科大学附属第一医院心内科,辽宁大连116000 [2]大连机车医院心内科,辽宁大连116000

出　　处：《中国当代医药》2022年第10期62-66,70,共6页China Modern Medicine

摘　　要：目的 探讨心电图aVR导联ST段变化对非ST段抬高型急性冠脉综合征(NSTE-ACS)患者的影响。方法 回顾性选取2019年7月至2020年7月大连医科大学附属第一医院收治的168例NSTE-ACS患者作为研究对象,根据患者入院发病时测量的心电图a VR导联ST段抬高程度分为非STaVR段抬高组(65例)、STaVR段抬高0.05~<0.1 mV组(58例)与STaVR段抬高≥0.1 mV组(45例)。记录三组患者临床资料及6个月内主要心脏不良事件(MACE)发生情况并进行统计学分析。结果 三组患者的心肌梗死史、左心射血分数(LVEF)、Killip分级、病变血管支数及治疗方案比较,差异有统计学意义(P<0.05)。三组患者心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CKMB)、脑钠肽(BNP)及超敏C反应蛋白(hs-CRP)水平比较,差异有统计学意义(P<0.05);STaVR段抬高≥0.1 mV组、STaVR段抬高0.05~<0.1 mV组的cTnI、CK-MB、BNP及hs-CRP水平高于非STaVR段抬高组,STaVR段抬高≥0.1 m V组高于STaVR段抬高0.05~<0.1 mV组,差异有统计学意义(P<0.05)。三组患者6个月内(再发)心肌梗死、心血管死亡及血运重建发生率比较,差异有统计学意义(P<0.05);STaVR段抬高≥0.1 mV组、STaVR段抬高0.05~<0.1 mV组的(再发)心肌梗死、心血管死亡及血运重建发生率高于非STaVR段抬高组,STaVR段抬高≥0.1 m V组高于STaVR段抬高0.05~<0.1 mV组,差异有统计学意义(P<0.05)。6个月内发生与未发生MACE的NSTE-ACS患者在非STaVR段抬高、STaVR段抬高0.05~<0.1 mV及STaVR段抬高≥0.1 mV的分布情况比较,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,LVEF(β=0.288,OR=1.586,95%CI=1.267~2.831)、Killip分级(β=0.271,OR=1.716,95%CI=1.359~2.498)、病变血管支数(β=0.743,OR=2.247,95%CI=1.664~3.576)、cTnI(β=0.553,OR=2.093,95%CI=1.537~3.498)、CK-MB(β=1.105,OR=2.358,95%CI=1.239~3.869)、BNP(β=0.934,OR=1.529,95%CI=0.913~2.722)、hs-CRP(β=0.326,OR=1.768,95%CI=1.175~2.246)及STaVR段抬高(β=0.179,OR=1.452,95%CI=1.123~2.0Objective To discuss the effect of ST segment changes in lead aVR of patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS).Methods A total of 168 patients with NSTE-ACS in the First Affiliated Hospital of Dalian Medical University from July 2019 to July 2020 were analyzed retrospectively,and divided into the non STaVR segment elevation group(65 cases),STaVR segment elevation 0.05-0.1 mV group(58 cases)and STaVR segment elevation≥0.1 mV group(45 cases)according to the ST segment degree of improvement in lead aVR measurements at admission.The baseline data,occurrence of MACE within 6 months of three groups of patients were recorded and analyzed.Results The history of myocardial infarction,left ventricular ejection fraction(LVEF),Killip grade,number of diseased vessels and treatment regimen of the three groups were significant differences(P<0.05).The cTnI,CK-MB,BNP and hs-CRP levels of the three groups were significant differences(P<0.05);The cTnI,CK-MB,BNP and hs-CRP levels of STaVR segment elevation≥0.1 mV group and STaVR segment elevation 0.05-0.1 mV group were higher than those of the non STaVR segment elevation group,the STaVR segment elevation≥0.1 mV group were higher than the STaVR segment elevation 0.05-0.1 mV group,and the differences were statistically significant(P<0.05). The (repeat) myocardial infarction, cardiovascular death and revascularization incidence rates of the three groups within 6 months were significant different (P<0.05). The (repeat) myocardial infarction, cardiovascular death and revascularization incidence rates of the STaVR segment elevation ≥0.1 mV group and the STaVR segment elevation 0.05-0.1 mV group were higher than those of the non STaVR segment elevation group, the STaVR segment elevation ≥0.1 mV group were higher than the STaVR segment elevation 0.05-0.1 mV group, the differences were statistically significant (P<0.05). The distribution of non STaVR segment elevation, STaVR segment elevation 0.05-0.1 mV and STaVR segment elevation ≥0.1 mV of NSTE-A

关 键 词：心电图 AVR导联 非ST段抬高型急性冠脉综合征 主要心脏不良事件 

分 类 号：R543[医药卫生—心血管疾病]