AMI患者心电图碎裂QRS波发生情况与梗死部位及严重心律失常的关系

Relation between fragmented QRS complex and area of infarction,severe arrhythmia in cases of acute myocardial infarction

目的探讨急性心肌梗死(AMI)时碎裂QRS波(QRSf)及其出现导联数在临床检测心律失常所致心源性猝死高危者中的作用。方法回顾性分析162例AMI患者入院后3 d心电图QRSf发生情况,并分析其与梗死部位及严重心律失常(SAR)的关系。结果心电图出现QRSf者高度以上房室阻滞、房扑/房颤、室性早搏、多形室速、室扑/室颤发生率及下壁心梗分布率均显著高于无QRSf者(P<0.05);QRSf出现在2个导联以上者多形室速、室扑/室颤发生率显著高于出现在2个导联者(P<0.05)。结论 AMI患者QRSf发生情况与梗死部位及SAR(尤其是恶性室性心律失常)发生密切相关,QRSf出现在多导联者应作为高危人群进行早期干预治疗,以避免心源性猝死的发生;QRSf导联分布及数量是否与心律失常发生有关尚需进一步研究。

Objective To investigate the value of fragmented QRS complex（QRSf） and number of its leads in the diagnosis of acute myocardial infarction（AMI）patients who are in danger of sudden cardiac death by arrhythmia.Methods The occurrences of QRSf,and its relation with area of infarction and severe arrhythmia（SAR） were analyzed retrospectively in 162 patients with AMI.Results The incidence rates of atrioventricular block,atrial flutter/fibrillation,premature ventricular contraction,multiform ventricular tachycardia and ventricular fibrillation in patients with QRSf were significantly higher than those without（P〈0.05）;the incidence rates of multiform ventricular tachycardia and ventricular flutter/fibrillation in patients with QRSf at 〉2 leads were significantly higher than those in patients with QRSf at 2 leads.Conclusions The occurrences of QRSf are highly correlated with area of infarction and SAR（especially malignant ventricular arrhythmia）,patients with QRSf occurs in multi-leads should be given pertinent treatment as soon as possible,in case of sudden cardiac death;correlation between the leads distribution,occurrences of QRSf and arrhythmia need further study.