不同心肌缺血程度急性ST段抬高型心肌梗死患者心电图QRS波群变化及其对严重心律失常的预测价值  

Changes of electrocardiographic QRS complex in patients with acute ST-segment elevation myocardial infarction with different degree of myocardial ischemia and its predictive value for severe arrhythmias

作　　者：王鸿雁 赵巧文 黄莉 WANG Hong-yan;ZHAO Qiao-wen;HUANG Li(ECG Room,Yulin Xingyuan Hospital,Yulin,Shaanxi,719000,China)

机构地区：[1]榆林市星元医院心电图室,陕西榆林719000 [2]西安交通大学第一附属医院榆林医院

出　　处：《心血管康复医学杂志》2025年第1期95-98,共4页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨不同心肌缺血程度急性ST段抬高型心肌梗死(STEMI)患者心电图QRS波群的变化及其对严重心律失常(SA)的预测价值。方法:选择榆林市星元医院2020年1月-2021年1月期间收治的STEMI患者122例,根据入院时心电图QRS波群形态分为Ⅱ级缺血组(49例)和Ⅲ级缺血组(73例)。比较两组患者入院时和静脉溶栓2h后心电图ST变化及住院期间SA发生率。采用多因素Logistic回归分析STEMI患者SA发生的影响因素。结果:与Ⅱ级缺血组比较,Ⅲ级缺血组入院时ST段抬高幅度(∑ST)[0.87(0.62,1.10)mV比0.42(0.29,0.57)mV]、静脉溶栓2h后∑ST[0.47(0.34,0.61)mV比0.12(0.09,0.15)mV]和住院期间SA发生率(36.73%比9.59%)显著升高(P均<0.001),静脉溶栓2h后ST段回落≥50%比例(59.18%比84.93%)显著降低(P<0.001)。多因素Logistic回归分析显示,发病至静脉溶栓时间、入院时∑ST、静脉溶栓2h后∑ST、心肌缺血Ⅲ级是STEMI患者SA发生的独立危险因素(OR=1.240~3.236,P<0.05或<0.01),静脉溶栓2h后ST段回落≥50%为其独立保护因素(OR=0.480,P=0.030)。结论:Ⅲ级心肌缺血是STEMI患者SA发生的独立危险因素,心肌缺血可能成为STEMI患者SA发生的预测指标。Objective:To investigate the changes of QRS complex in ECG in patients with acute ST-segment elevation myocardial infarction(STEMI)with different degree of myocardial ischemia and its predictive value for severe arrhythmias(SA).Methods:A total of 122 STEMI patients treated in Yulin Xingyuan Hospital between January 2020 and January 2021 were selected and divided into grade II ischemia group(n=49)and grade III ischemia group(n=73)according to morphology of QRS complex at admission.ST segment change in ECG at admission and 2h after intravenous thrombolysis and incidence of SA during hospitalization were compared between two groups.Multivariate Logistic regression was used to analyze influencing factors for SA in STEMI patients.Results:Compared with grade II ischemia group,patients in grade III ischemia group had significant higher amplitude of ST segment elevation(∑ST)at admission[0.87(0.62,1.10)mV vs.0.42(0.29,0.57)mV],∑ST on 2h after intravenous thrombolysis[0.47(0.34,0.61)mV vs.0.12(0.09,0.15)mV]and incidence rate of SA during hospitalization(36.73%vs.9.59%)(P<0.001 all),and significant lower proportion of ST segment resolution≥50%on 2h after intravenous thrombolysis(59.18%vs.84.93%)(P<0.001).Multivariate Logistic regression analysis indicated that onset-to-thrombolysis time,∑ST at admission,∑ST on 2h after intravenous thrombolysis and myocardial ischemia grade III were independent risk factors for SA in STEMI patients(OR=1.240~3.236,P<0.05 or<0.01),while ST segment resolution≥50%on 2h after intravenous thrombolysis was its independent protective factor(OR=0.480,P=0.030).Conclusion:Grade III myocardial ischemia is an independent risk factor for SA in STEMI patients,and myocardial ischemia may be a predictor for SA in STEMI patients.

关 键 词：心肌梗死 心律失常 心肌缺血 心电描记术 

分 类 号：R542.22[医药卫生—心血管疾病]