ST段抬高型心肌梗死患者胸前导联QRS波群特征与短期预后的关系  

The Relationship Between Chest Lead QRS Complex Characteristics and Short-term Prognosis in Patients with ST Segment Elevation Myocardial Infarction

作　　者：单二伟 SHAN Erwei(Department of Cardiovascular,Huai’an 82nd Hospital,Huai’an,Jiangsu 223001,China)

机构地区：[1]淮安八十二医院心血管内科,江苏淮安223001

出　　处：《中国医药指南》2025年第2期78-80,共3页Guide of China Medicine

摘　　要：目的探究ST段抬高型心肌梗死(STEMI)患者胸前导联QRS波群特征与短期预后的关系。方法选取2018年1月至2024年1月淮安八十二医院收治的240例STEMI患者,根据住院期间的主要不良心血管事件(MACE)发生情况分组,将发生MACE的患者纳入MACE组(64例),将未发生MACE的患者纳入预后良好组(176例),两组患者均接受心电图检查。比较两组胸前导联QRS波群特征差异,采用Spearman分析法分析胸前导联QRS波群特征与MACE的相关性,采用ROC曲线分析STEMI患者胸前导联QRS波群特征对MACE的预测效能。结果MACE组的QRS波群时限、病理性Q波、fQRS、ST段抬高累计胸前导联个数≥3个、R波幅度总和高于预后良好组(P<0.05)。MACE组的R/(S+Q)低于预后良好组(P<0.05)。两组J点抬高、(Q波+S波)幅度总和、QRS幅度总和比较无差异(P>0.05)。Spearman分析结果显示,STEMI患者的MACE与QRS波群时限、病理性Q波、fQRS、ST段抬高累计胸前导联个数、R波幅度总和呈正相关,与R/(S+Q)呈负相关(P<0.05)。ROC曲线分析结果显示,QRS波群时限、病理性Q波、fQRS、ST段抬高累计胸前导联个数、R波幅度总和预测MACE的AUC分别为0.705、0.604、0.619、0.614、0.648、0.725。结论STEMI患者的胸前导联QRS波群特征与短期预后密切相关,且对于短期不良预后结局具备较高的预测效能,具备一定的临床借鉴价值。Objective To explore the relationship between the characteristics of the precordial QRS complex in patients with ST-segment elevation myocardial infarction(STEMI)and their short-term prognosis.Methods A total of 240 STEMI patients admitted to Huai’an 82nd Hospital from January 2018 to January 2024 were selected.Patients were grouped based on the occurrence of major adverse cardiovascular events(MACE)during hospitalization.Patients with MACE were included in the MACE group(64 cases),and those without MACE were included in the good prognosis group(176 cases).Both groups underwent electrocardiogram(ECG)examination.The differences in precordial QRS complex characteristics between the two groups were compared.The Spearman analysis was used to analyze the correlation between precordial QRS complex characteristics and MACE,and the ROC analysis was used to evaluate the predictive efficacy of precordial QRS complex characteristics for MACE in STEMI patients.Results The QRS duration,pathological Q wave,fragmented QRS(fQRS),the number of precordial leads with ST-segment elevation≥3,and the sum of R-wave amplitudes were higher in the MACE group than in the good prognosis group(P<0.05).The R/(S+Q)ratio was lower in the MACE group than in the good prognosis group(P<0.05).There was no statistically significant difference in J-point elevation,the sum of Q-wave and S-wave amplitudes,and the total QRS amplitude between the two groups(P>0.05).Spearman analysis showed that MACE in STEMI patients was positively correlated with QRS duration,pathological Q wave,fQRS,the number of precordial leads with ST-segment elevation,and the sum of R-wave amplitudes,and negatively correlated with the R/(S+Q)ratio(P<0.05),but not correlated with J-point elevation,the sum of Q-wave and S-wave amplitudes,or total QRS amplitude(P>0.05).The ROC curve analysis showed that the AUC for predicting MACE with QRS duration,pathological Q wave,fQRS,the number of precordial leads with ST-segment elevation,and the sum of R-wave amplitudes were 0.705,0.604,0.

关 键 词：ST段抬高型心肌梗死 QRS波 短期预后 预测效能 

分 类 号：R542.22[医药卫生—心血管疾病]