非ST段抬高急性心肌梗死病人QRS时限延长的临床特点分析

Significance of QRS prolongation in non-ST elevation acute myocardial infarction

目的 研究非ST段抬高急性心肌梗死 (NSTEMI)病人在无束支传导阻滞的情况下 ,QRS时限延长的临床意义。方法 共入选 5 9名NSTEMI病人 ,根据心电图 (ECG)QRS时限将病人分为两组 :QRS≥ 10 0ms组 ( 3 6名 )和QRS <10 0ms组 ( 2 3名 )。分别比较两组病人的临床特点及分析预后意义。结果 QRS≥ 10 0ms的NSTEMI病人年龄较大 ( 69± 11.8vs 61.8± 13 .1,P <0 .0 5 )且合并糖尿病的人数较QRS <10 0ms组的多 ( 15 / 2 3vs 10 / 3 6,P <0 .0 1) ;临床上KillipII级以上的人数前组也较后组多 ( 8/ 2 3vs 4/ 3 6,P <0 .0 5 ) ;肌酸激酶同工酶 (CK -MB)及肌钙蛋白 (Tni)的峰值前组显著高于后组 ( 60± 49.5vs 3 8.6± 2 1.4;17.75± 15 .1vs5 .5 7± 5 .46,P <0 .0 5 ) ;超声心动图心脏功能 (LVEF)前组显著低于后组 ( 4 9.1± 9.8vs 5 6.2± 6.2vsP <0 .0 5 ) ;冠状动脉造影显示QRS≥ 10 0ms组的病人 3支及左主干病变也显著多于QRS <10 0ms组 ( 10 / 12vs 12 / 2 8,P <0 .0 5 ) .结论 对于NSTEMI病人 ,在无束支传导阻滞的情况下 ,ECG上QRS时限延长组糖尿病病人较多 ,病人心肌损害严重 ,心功能差 ,冠状动脉病变多为多支病变 。

Objective To study the clinical significance of increasing QRS duration in the absence of bundle block(BBB) on the presenting electrocardiogram of patients with non-ST elevation acute myocardial infarction(NSTEMI). Method Depending on the QRS duration, the 59 patients with NSTEMI were divided into the two groups: QRS≥100ms (36)and <100ms(23). The clinical characters, creatine kinase isozyme( CK-MB) and tropin( Tni) ,cardiac function and coronary angiogram(CAG)were determined and compared. Result In patients with QRS≥100ms were more likely to be elder(69±11.8 vs 61.8±13.1, P <0.05) and diabetes(15/23 vs 10/36, P <0.01) and be in Killip II,III or IV(8/23 vs 4/36, P <0.05), to higher peak value of CK-MB and Tni (60±49.5 vs 38.6±21.4;17.75±15.1 vs5.57±5.46, P <0.05),to have lower left ventricular ejection fraction(LVEF, 49.1±9.8 vs 56.2±6.2, P <0.05) and to have more 3-vessel and left main disease in CAG(10/12 vs 12/28, P <0.05) .Conclusion For the NSTEMI patients, QRS prolongation ≥100ms is associated with severe ischemia and multivessel coronary artery disease and left ventricular dysfunction, indicate patients of NSTEMI with QRS≥100ms have a poor prognosis.