陈旧性心肌梗死碎裂QRS波及碎裂QRS时限与室性心律失常的关系

Relationship of the fragmented QRS and the fragmented QRS time limit with ventricular arrhythmia in old myocardial infarction

目的通过分析陈旧性心肌梗死（OMI）伴碎裂QRS波（fQRS）患者和不伴fQRS患者以及不同fQRS时限患者发生室性心律失常的情况，探讨OMI患者fQRs、fFQRS时限与室性心律失常的关系。方法选择321例OMI患者进行常规心电图检查，根据心电图有无fQRS分为OMI伴fQRS组（A组，167例）和OMI不伴fQRS组（B组，154例）。A组将出现fQRS的导联加长描记50mm／s心电图，连续测量3个fQRS时限，取其平均值，根据fQRS时限的数值分为≤0．100s组（x组，96例）、0．101—0．119s组（Y组，54例）、≥0．120s组（z组，17例）。所有患者均进行24h动态心电图检查，统计分析室性心律失常的发生情况。结果A组室性心律失常发生率为78．4％（131／167），B组为63．6％（98／154），两组比较差异有统计学意义（P〈0．01）；A组室性期前收缩〉720个／24h发生率为28．7％（48／167），B组为17．5％（27，154），两组比较差异有统计学意义（P〈0．05）；A组多形性室性期前收缩、成对室性期前收缩、非持续性室性心动过速、室性期前收缩Lown分级3～5级发生率分别为16．2％（27／167）、33．5％（56／167）、12．0％（20，167）、34．1％（57／167），B组分另0为7．8％（12／154）、21．4％（33／154）、4．5％（7／154）、23．4％（36／154），两组比较差异有统计学意义（P〈0．05）。z组室性心律失常发生率[100．0％（17／17）]显著高于Y组[79．6％（43／54）]和X组[74．0％（71／96）]，差异均有统计学意义（P〈0．05）。Z组室性期前收缩Lown分级3～5级发生率[70．6％（12／17）]显著高于Y组[42．6％（23／54）]和x组[22．9％（22／96）]，Y组显著高于X组，差异均有统计学意义（P〈0．05）。结论OMI伴fQRs患者较OMI不伴fQRs患者的室性心律失常发生率增加且较严重，并且随着fQRS时限的增宽，室性期前收缩的发生次数明显增加，室性期前收缩Lown分级3～5级发生率也明显增加。所以fQRS是高危心肌梗死患者预警的心电图新指标，fQRS时限对预测OMI患者心脏事件的发生具有明确的价值。

Objective To explore the relationship of the fragmented QRS （fQRS） and the fQRS time limit with ventricular arrhythmia in old myocardial infarction （OMI） patients through contrasting the incidence of ventricular arrhythmia in OMI patients whether fQRS or not and ventricular arrhythmia in different fQRS time hmit. Methods According to the routine electrocardiogram, 321 OMI patients were divided into group A （fQRS appearance, 167 cases） and group B （fQRS non-appearance, 154 cases）. The lead with fQRS extense was chosen and traced another 50 mm/s electrocardiogram, and 3 consecutive fQRS time limit were measured and them average was taken in group A. According to the fQRS time limit, the patients in group A were divided into 3 groups： group X（ ≤0.100 s, 96 cases）, group Y （0.101-0.119 s, 54 cases） and group Z （90.120 s, 17 cases）. All the patients were continuously monitored with 24 hours dynamic electrocardiogram, and the incidence of ventricular arrhythmia was analyzed. Results The incidence of ventricular arrhythmia in group A [ 78.4% （ 131/167 ） ] was higher than that in group B [ 63.6% （98/154） ] （P 〈 0.01 ）. The incidence of premature ventrieular contraction （PVC） 〉 720/24 hours in group A [ 28.7%（48/167 ）] was higher than that in group B [ 17.5%（27/154）] （P 〈 0.05 ）. The incidence of multifocal PVC,enupled PVC, nonsustained ventricular tachyeardia and Lown 3-5 grades PVC was 16.2%（27/167 ）, 33.5% （56/167）, 12.0% （20/167）,34.1% （57/167） in group A,7.8% （12/154）,21.4% （33/154）,4.5% （7/154）, 23.4%（36/154） in group B, there were significant differences between two groups （P 〈 0.05 ）. The incidence of ventricular arrhythmia in group Z [ 100.0%（ 17/17 ）] was significantly higher than that in group Y [ 79.6% （43/54） ] and group X [ 74.0% （71/96 ） ] （P 〈 0.05 ）. The incidence of Lown 3-5 grades PVC in group Z[70.6%（12/17） ] was significantly higher than that in group Y[42.6%（23/54） ] and group X[22.9% （22/96） ], and the incidence of Lown 3-5 grades PVC in group Y was significantly higher than that in group X （P 〈 0.05）. Conclusions OMI patients with fQRS have higher incidence and severe degree in ventricular arrhythmia than those without fQRS .With the fQRS time limit widened, PVC and Lown 3-5 grades PVC significantly increased. So fQRS is a new predicting index of OMI, and fQRS time limit has definite value in predicting the heart event for OMI patients.