终末QRS变形与ST段测量估测急性前壁心肌梗死面积以及溶栓疗效的临床价值

Terminal QRS Distortion and ST-Segment Measurements Assessing Final Infarct Size and the Effect of Thrombolytic Therapy in Anterior Wall Acute Myocardial Infarction.

利用SelvesterQRS计分系统,比较ST段测量与QRS终末变形对急性前壁心肌梗死(简称心梗)患者最后梗死面积和溶栓治疗效果的影响。选择644例第一次急性前壁心梗患者,其中398例接受溶栓治疗,246例未接受溶栓治疗。从入院时首次稳定心电图上估计ST段抬高的导联数目、ST段抬高的幅度(∑ST)及QRS终末形态。根据QRS终末变形存在与否将患者分为两组:QRS终末变形(QRS+)组,QRS终末无变形(QRS-)组。利用修改的SelvesterQRS计分系统,从出院前心电图上估计最后梗死面积。结果:接受与未接受溶栓治疗者QRS+组∑ST、ST段抬高导联数大于QRS-组,差异有显著性(P<0.05)。在QRS-和QRS+者,溶栓治疗均能减少Selvester计分;但最后梗死面积的减少仅在QRS-的患者有意义(P<0.01)。ST段抬高的幅度与最后梗死面积之间无相关性;ST段抬高导联数仅与溶栓治疗者的最后梗死面积有关(r=0.25141,P≤0.05)。溶栓组QRS+者无复灌流率较QRS-者高。结论:QRS终末变形较ST段测量能更好地估测急性前壁心梗患者的最后梗死面积和溶栓治疗的效果。

This study used QRS score system of Selvester to compare terminal QRS distortion and ST-segment measurements in assessing the effect of final infarct size and thrombolytic therapy in anterior wall acute myocardial infarction（AMI）, ST-segment measurements and the initial electrocardiographic pattern （terminal QRS distortion） were determined on the first stable electrocardiogram of 644 patients with first anterior wall AMI, Patients were divided into two initial patterns according to the absence or presence of terminal QRS distortion：QRS ^＋ and QRS^-. Infarct size was assessed by the predischarge electrocardiograms using the modified QRS score system of Selvester, Results ：398 patients received thrombolytic therapy and 246 patients did not receive thrombolytic therapy. （1）Thrombolytic therapy reduced Selvester score only in the QRS^- patients （ P ≤0.05 ）, but not in the QRS ^＋ patients（ P 〉0.05）, （2）Infarct size was more in the QRS^＋ patients than that in the QRS^- patients; QRS ^＋ can be used as an index of big infarct size, （3）Of 644 patients with anterior AMI , there was no correlation between ∑ ST and Selvester score . There was correlation between the number of leads with ST elevation and Selvester score only in the patients receiving thrombolytic therapy（ r =0. 25141 ,P≤ 0.05 ）. （4）The rate of angiographic no-reflow was higher in the QRS^＋ patients than in the QRS^- patients. Conclution：Terminal QRS distortion on admission is better than ST-segment measurements in assessing final infarct size and the effect of thrombolytic therapy in anterior wall AMI. [ Chinese Journal of Cardiac Pacing and Electrophysiology, 2005,19 （ 5 ） ： 361 - 364 ]