心电图碎裂QRS波在急性心肌梗死诊断中的应用价值分析

Application value of electrocardiographic fragmented QRS in the diagnosis of acute myocardial infarction

目的探讨心电图碎裂QRS波在急性心肌梗死诊断中的应用价值,为该病的心电图诊断提供依据。方法回顾性分析本院收治的239例冠心病患者(其中102例为急性心肌梗死患者)的临床资料,以冠状动脉造影结果为金标准,分析碎裂QRS波、病理性Q波和碎裂QRS波合并病理性Q波在急性心肌梗死诊断中的敏感性、特异性。对比以上心电图指标在不同部位心肌梗死诊断中的敏感性和特异性。结果碎裂QRS波诊断急性心肌梗死的敏感性为21.57%,与病理性Q波比较差异无显著性(P>0.05),碎裂QRS波的特异性和阳性预测值分别为95.62%和78.57%,均显著高于病理性Q波(P均<0.05)。碎裂QRS波合并病理性Q波诊断急性心肌梗死的敏感性为40.2%,显著高于碎裂QRS波(P<0.05),而两项指标的特异性和阳性预测值对比差异无显著性(P>0.05)。碎裂QRS波合并病理性Q波在前壁和侧壁心肌梗死诊断中的敏感性显著高于碎裂QRS波和病理性Q波(P<0.05),三者在下壁心肌梗死诊断中的敏感性比较差异无显著性(P>0.05),且三者在下壁、前壁、侧壁心肌梗死诊断中的特异性比较差异无显著性(P>0.05)。结论碎裂QRS波可作为急性心肌梗死诊断的重要指标,联合病理性Q波可进一步提高心电图在急性心肌梗死诊断中的应用价值。

Objective To explore the application value of electrocardiographic fragmented QRS in the diagnosis of acute myocardial infarction, and to provide the basis for the ECG in the diagnosis of the disease. Method A retrospective analysis of 239 cases of coronary heart disease patients admitted to our hospital （including 102 cases of acute myocardial infarction in patients with clinical data）, to the results of coronary angiography as the gold standard, of fragmented QRS complex, pathological Q wave and fragmentation of QRS and pathological Q wave sensitivity, specificity in diagnosis of acute myocardial infarction. Sensitivity and speciifcity compared the above electrocardiographic criteria in different parts of diagnosis of acute myocardial infarction. Result The sensitivity of fragmented QRS wave in diagnosis of acute myocardial infarction was 21.57%, compared to the pathologic Q wave, the difference was not statistically signiifcant （P〉0.05）, but the speciifcity and positive predictive value of fragmented QRS wave was 95.62%and 78.57%, were signiifcantly higher than those of pathological Q wave （P〈0.05）. Sensitivity to fragmentation of QRS wave and Q wave in pathological diagnosis of acute myocardial infarction was 40.20%, signiifcantly higher than that of fragmented QRS complex （P〈0.05）. Compared two indicators of speciifcity and positive predictive value, the difference was not statistically signiifcant （P〉0.05）. The sensitivity of fragmented QRS and pathological Q wave in the diagnosis of anterior wall and lateral wall myocardial infarction were signiifcantly higher than that of fragmented QRS and pathological Q wave （P〈0.05）. Conclusion QRS can be used as an important index fragmentation in the diagnosis of acute myocardial infarction, and combined pathological Q wave diagnosis can further improve the ECG in the diagnosis of acute myocardial infarction.