以QRS记分法比较心肌梗死延展和再梗死的面积及心衰、心脏性休克的发生率

Comparison of the infarct size and incidence of heart failure and cardiogenic shock between reinfarction and infarct extension with QRS scoring system.

目的 探讨急性心肌梗死 (AMI)后 ,近期 (4周一半年内 )再次心肌梗死 (再梗死 RI)和梗死延展 (IE)发生后二者梗死面积及心衰、心脏性休克发生率的差异。方法 对 2 32例 AMI患者采用 Wagner心电图记分法 ,选取 AMI充分发展期及 RI和 IE后的稳定期 ,进行 QRS记分。结果 IE和 RI发生后 QRS记分值较两种病变发生前明显增加 ,P均 <0 .0 1。 RI患者 QRS记分值多于 IE患者 ,P<0 .0 5。RI患者心衰及心脏性休克的发生率明显高于 IE患者 ,P均 <0 .0 2 5。 IE和 RI后出现心衰患者发病前后 QRS记分值比较有明显差异 ,P均 <0 .0 1。无心衰患者发病前后 QRS记分值无差异 ,P均 >0 .0 5。以 QRS记分增加值 1.5分为界 ,与 IE和 RI发生前比较 QRS记分增加值超过 1.5分者心衰及心脏性休克的发生率明显多于未超过 1.5分者。结论 RI患者的梗死面积大于 IE患者。发生 IE和 RI后梗死面积增加越多即 QRS记分增加值越大 ,心功能越差 ,心源性休克及心衰发生率越高 ,QRS记分增加值超过 1.5分者预后不佳。

Objective To investigate the difference of the infarct size and incidence of heart failure (HF) and cardiogenic shock (CS) in early stage (4 weeks-6months)of AMI.Methods Wanger's QRS scoring system was used to assess 232 cases with AMI.QRS score was evaluated in progressive stage,stable stage of RI and IE.Results Both QRS score in RI and IE were significantly higher than premobid score(5.9±3 5 to 4.9±3.1,6.6±3.9 to 4.7±2.9; P <0.01).Patient with RI had higher QRS score than patient with IE ( P <0.01),incidence of HF and CS in the patient with RI was also higher than that of patient with IE( P <0.025).Significant difference of QRS score in HF was found between pre-and post-onset in patient with RI and IE.However,there was no significant difference in patient without HF.Score 1.5 as criterion,incidence of HF and CS in patient whose QRS score increased over 1.5 was higher than those of under 1.5.Conclusion Patient with RI had larger infarct size than patient with IE.The increase in QRS score develop the higher incidence of HF and CS.QRS score increasing over 1.5 suggest poor prognosis.