碎裂QRS波在急性ST段抬高型心肌梗死中的临床价值

Clinical value of fragmented QRS complex in the patients of acute ST elevation myocardial infarction

目的探讨碎裂QRS波在急性sT段抬高型心肌梗死中的临床价值。方法回顾分析经急诊介入术的急性sT段抬高型心肌梗死362例，根据入院时是否存在叼RS波分为的Rs组和N．fQRS组，通过观察临床资料、冠状动脉造影、超声心动图以及住院期间心脏事件发生率，对比2组间的差异。结果362例患者地Rs组132例，N-fQRS组230例，叼Rs发生率36．46％，fQRS组较N-fQRS组心肌酶升高、发病到入院时间延长，差异有统计学意义（P〈0．05）；冠状动脉造影提示妁RS组比N．叼RS组更多见前降支、多支血管病变者（53．8％W38．7％，50．8％US33．9％，P〈0．05）；超声心动图显示左心室射血分数更低（P=O．001），左心室室壁瘤（P=0．001）和住院期间恶心心律失常发生率增高（P〈0．05），心功能KiUip 3～4级发生率高（P=0．001），但心源性死亡两组未见异常（P=-0．132）。结论fQRS波可以协助判断急性ST段抬高型心肌梗死血管病变以及心功能、恶性心律失常发生，可作为预测住院期期预后的一个心电学指标。

Objective To explore the clinical value of fragmented QRS complexes （fQRS） for the disease of acute ST segment elevation myocardial infarction （STEMI）. Methods This was a retrospective analysis of 362 patients who underwent emergency percutaneous coronary intervention （PCI）. We divided the patients into two groups, fQRS and N-fQRS group, according to their electrocardiograms （ECG） during on admission. Comparatively statistical analyses were made on the data including clinical indexes, coronary angiogram, echocardiography and the incidence of major adverse cardiac events （MACE）. Results 132 cases were in fQRS group and 230 cases were in N-fQRS group. The incidence of fQRS was 36.46%. Patients of fQRS group usually had higher morbidity of LAD infarction and multi-vessel disease （53.8% vs 38.7%, 50.8% vs 33.9%, P〈0.05）. The fQRS group had higher CK-MB levels （P〈0.05）. The time from occurrence to on admission was also longer for the fQRS group （P〈0.05）. There were also lower left ventricular ejection fraction （P=0.001）, more incidence of ventricular aneurysm （P=-0.001）, malignant arrhythmia （P〈0.05） and higher heart function Killip Ⅲ-Ⅳ incidence （P=0.001） during hospitalization for the fQRS group. Cardiovascular death showed no significant difference between two groups （P--0.132）. Conclusion The occurrence of fQRS can be a taken as a electro cardiology index to value the risk of maculopathy, heart function and malignant arrhythmia for acute STEMI patients during hospitalization.