经皮冠状动脉介入治疗严重心力衰竭患者QRS时间变化与临床治疗效果的关系研究

The association between the efficacy of percutaneous coronary intervention and QRS pattern in patients with severe heart failure

目的观察严重心力衰竭患者接受经皮冠状动脉介入（PCI）治疗疗效与QRS形态的关系。方法2011年1月至2014年5月收治的严重心力衰竭患者122例，根据入院时心电图QRS形态分为碎裂QRS波群（fQRS）组（62例）和无碎裂QRS波群（nfQRS）组（60例）。比较两组左心室射血分数（LVEF）、左心室舒张末容积指数（LVEDVI）、6min步行试验（6MWT）及预后情况。结果治疗前LVEF、LVEDVI、6MWT两组间差异均无统计学意义（均P＞0.05）；两组LVEF、LVEDVI、6MWT治疗前后比较差异均有统计学意义（t=2.172、2.144、2.158,2.043、2.077、2.018，均P＜0.05）；治疗后LVEF、LVEDVI、6MWT fQRS组较nfQRS组显著改善，差异均有统计学意义（t=2.133、2.058、2.107，均P＜0.05）。fQRS组患者出现心源性休克、心律失常、重度房室传导阻滞、死亡发生率高于nfQRS组，差异均有统计学意义（χ2=4.307、5.302、4.441、4.873，均P＜0.05）。结论 PCI治疗严重心力衰竭效果确切，nfQRS患者恢复好于fQRS组。

Objective To assess the association between the efficacy of percutaneous coronary intervention （PCI） and QRS pattern in patients with severe heart failure. Methods 122 patients with severe heart failure from January 2011 to May 2014 were enrol ed. They were divided into fragmented QRS （fQRS） group （62 cases） and non- fragmented QRS （nfQRS） group （60 cases） based on ECG recorded at admission. Left ventricular ejection fraction （LVEF）, left ventricular end- diastolic volume index （LVEDVI）, 6- minute walking test （6 MWT） and prognosis were compared between the two groups. Results LVEF, LVEDVI and 6MWT were similar between the two groups before PCI. Al these parameters were improved significantly after PCI in both groups （t=2.172、2.144、2.158,2.043、2.077、2.018, P〈0.05） and more significantly in nfQRS group than in fQRS group （t=2.133、2.058、2.107, P〈0.05）. The incidences of cardiac shock, arrhythmia, severe atrioventricular block and death were significantly higher in fQRS group than in nfQRS group （χ2= 4.307, 5.302, 4.441, 5.302, P〈0.05）. Conclusion PCI may improve severe heart failure, especial y in patients with nfQRS.