心电图动态观察对急性左心衰患者的预后评价

Prognostic evaluation of the acute left heart failure patients by the dynamic observation of ECG

目的探讨心电图QRS波时限和Q-Tc间期以及二者的动态变化对急性左心衰竭(ALHF)患者的预后评价。方法选择2008年6月～2011年6月广东省深圳市宝安区中医院就诊的ALHF患者176例,在急性发作6 h内及首检后24、72 h行常规心电图检查,测量QRS波时限及Q-Tc间期,并计算其首检后24、72 h的变化率。依据患者出院情况分为预后良好组(n=86)、预后不良组(n=59)和死亡组(n=31),分析三组患者各时点QRS波时限和Q-Tc间期及变化率,以评价其预测作用。结果预后良好组首检后24、72 h的QRS波时限、Q-Tc间期较急性发作6 h内下降,各时点之间比较,差异有统计学意义(P<0.05),其余两组组内各时点QRS波时限及Q-Tc间期变化差异无统计学意义(P>0.05);预后不良组及死亡组首检后24 h的Q-Tc间期及首检后72 h的QRS波时限、Q-Tc间期长于预后良好组,差异有统计学意义(P<0.05);预后不良组、死亡组的RATEQ-RS2、RATEQ-RS3、RATEQ-Tc2、RATEQ-Tc3与预后良好组比较,差异均有统计学意义(均P<0.05);预后不良组与死亡组的RATEQ-RS2、RATEQ-RS3、RATEQ-Tc3比较,差异无统计学意义(P>0.05),两组RATEQ-Tc2比较差异有统计学意义(P<0.05)。结论多时点的QRS波时限、Q-Tc间期以及二者的变化率能较好的预测ALHF患者的预后。

Objective To explore the evaluation of prognosis of acute left heart failure （ALHF） by QRS prolongation and Q-Tc duration on standard ECG and their dynamic observation. Methods 173 cases of ALHF from June 2008 to June 2011 in TCM hospital of Baoan District in Shenzhen City were selected, QRS prolongation and Q-Tc duration on standard ECG were measured at 6 h within acute attack, 24 and 72 hours after first inspection, and the rate of change 24 and 72 hours after first inspection were calculated. The patients were assigned into well-prognosis group （n = 86）, poor-prognosis group （n = 59）, death group （n = 31） on the basis of NYHA class when they were out of hospital. Their QRS prolongation and Q-Tc duration of each time of point and the rate of change were analyzed and used to evaluate the prognosis of ALHF. Results QRS prolongation and Q-Tc duration of well-prognosis group were found lower 24 and 72 hours after first inspection than those 6 h within acute attack, the differences were statistically significant a- mong each time of point （P 〈 0.05）, and the differences of QRS prolongation and Q-Tc duration in poor-prognosis group and death group were not statistically significant （P 〉 0.05）; Q-Tc duration 24 hours after first inspection and QRS prolongation and Q-Tc duration 72 hours after first inspection in poor-prognosis group and death group were longer than those in well-prognosis group, the differences were statistically significant （P 〈 0.05）; the differences of RATFQ-RS2, RATEQ-RS3, RATEQ-Te3, and RATEQ-Te3 in poor-prognosis group, death group and well-prognosis group were statistically significant （P 〈 0.05）; the differences of RATE-RS2, RATEQ-RS3 and RATEQ-Tc3 in poor-prognosis group and death group were not statistically significant （P 〉 0.05）, the differences of RATE,Te-2 in the two groups was statistically significant （P 〈 0.05）. Conclusion The QRS prolongation and Q-Tc duration at many points and their rates of change have good evaluation on the prognosis Of ALHF.