急性心肌梗死患者碎裂QRS波的临床分析

Fragmented QRS Complex in Acute Myocardial Infarction Patients

目的探讨心电图碎裂QRS波(fQRS)在诊断急性心肌梗死(AMI)中的临床应用。方法比较fQRS在AMI患者和冠脉造影阴性者中的发生率。比较fQRS与病理性Q波在ST段抬高型AMI(STEMI)与非ST段抬高型AMI(NSTEMI)者中的发生率。比较有fQRS者与无fQRS者住院期间心律失常、再发心绞痛、左室射血分数(LVEF)降低(≤40%)、心源性休克和心源性死亡的发生率。结果 162例AMI者中有fQRS者36例(22.22%),对照组有fQRS者仅8例(4.94%)。观察组与对照组fQRS的发生率比较,差异有统计学意义(χ2=20.618,P<0.05)。NSTEMI者中fQRS的发生率高于病理性Q波(P<0.05)。有fQRS者住院期间心律失常、再发心绞痛、LVEF降低、心源性死亡的发生率明显高于无fQRS者(P<0.05)。结论 fQRS可作为心电图诊断AMI的一个新指标,尤其是对非Q波型急性心肌梗死、NSTEMI者,可减少漏诊;并可作为早期识别AMI高危人群的指标之一。

Objective To explore the value of fragmented QRS complex in the diagnosis of acute myocardial infarction（AMI）.Methods Incidence rates of fQRS among AMI patients and coronary arteriography（CAG） negative patients were compared;incidence rates of fORS and Q-wave among ST-segment elevation myocardial infarction（STEMI） patients and non-ST-segment elevation myocardial infarction（NSTEMI） patients,were compared.Further,incidence rates of arrhythmia,re-occur angina pectoris,decline in LVEF（≤40%）,cardiac shock and cardiac death of patients with and without fQRS were compared.Results Incidence rate of fQRS is higher among AMI patients（36 cases,22.22%） than among CAG negative patients（8 cases,4.94%）（χ2=20.618,P〈0.05）.In the cases of NSTEMI,fQRS is more frequently observed than Q-wave（P〈0.05）.Incidence rates of arrhythmia,re-occur angina pectoris,decline in LVEF,and cardiac death among patients with fQRS are significantly higher than those of fQRS-free patients（P〈0.05）.Conclusion FQRS could serve as a new indicator in the diagnosis of AMI,especially for cases of non-Q-wave myocardial infarction or NSTEMI.It can also considered as one of the early indicators for AMI severity.