超声心动图与QRS碎裂波对AMI患者中的变化及其意义

Changes and significance of echocardiography and QRS fragmented wave in patients with acute myocardial infarction

目的探讨超声心动图、心电图检查中QRS碎裂波(f QRS)在急性心肌梗死(AMI)患者中的检测及其意义。方法选取成都医学院第一附属医院于2013年5月~2016年5月高度怀疑为AMI并实施冠状动脉造影检查的113例患者作为研究对象,根据冠状动脉造影检查结果分为AMI组84例、非AMI组29例,对两组患者治疗前的超声心动图、心电图f QRS进行分析。亚组分析方法:将84例AMI患者分为f QRS波合并左室射血分数(LVEF)<50%组(A组),f QRS波合并LVEF≥50%合并f QRS波组(B组)、无f QRS波组(C组)。采用超声心动图检测左室舒张末期内径(LVEDD)、LVEF、心电图检测f QRS波、冠状动脉造影检测冠状动脉病变支数及病变程度并进行比较。结果 AMI组84例,平均年龄65.2±9.7岁,合并疾病:高血压29例、糖尿病14例、吸烟史27例。非AMI组29例,平均年龄63.8±10.4岁,合并疾病:高血压9例、糖尿病4例、吸烟史8例;两组患者的年龄、性别、合并疾病、吸烟情况差异不具有统计学意义(P>0.05)。与非AMI组相比,AMI组LVEDD值更高,而LVEF更低(P<0.05),AMI组的f QRS波检出率显著高于非AMI组(65.48%vs.34.49%,P<0.05);A组患者多支血管病变率(93.94%)显著的高于B组(68.18%)、C组(27.59%,P<0.05),B组患者的多支血管病变率(68.18%)显著高于C组(27.59%,P<0.05);A组患者完全闭塞率(48.18%)显著高于B组(13.64%)、C组(3.45%),差异有统计学意义(P均<0.05),B组患者的完全闭塞率(13.64%)与C组(3.45%)差异无统计学意义(P>0.05)。结论AMI患者的f QRS波发生率增高、心功能下降,并且与患者的病变程度具有一定的关系。

Objective To investigate the detection and significance of QRS fragmented wave（f QRS） in examinations of echocardiography and electrocardiogram（ECG） in patients with acute myocardial infarction（AMI）. Methods The patients（n=113） with suspected AMI undergone coronary angiography（CAG） were chosen from the First Affiliated Hospital of Chengdu Medical College from May 2013 to May 2016, and then divided, according to the outcomes of CAG, into AMI group（n=84） and non-AMI group（n=29）. The conditions of echocardiograph and f QRS of ECG were analyzed in 2 groups before treatment. The subgroup analysis was as follows： AMI patients（n=84） were divided into group of patients（50%） with f QRS＋LVEF（group A）, group of patients（≥50%） with f QRS＋LVEF（group B） and group of patients without f QRS（group C）. The indexes of left ventricular end-diastolic inner diameter（LVEDD） and left ventricular ejection fraction（LVEF） were detected by using echocardiography, f QRS was detected by using ECG, and lesion vessels and severity of coronary artery were detected by using CAG. Results There were 84 cases in AMI group（average age=65.2±9.7）, and 29 cases with hypertension, 14 with diabetes and 27 with smoking history. There were 29 cases in non-AMI group（average age=63.8±10.4）, and 9 with hypertension, 4 with diabetes and 8 with smoking history. The difference n age, sex, complications and smoking history had no statistical significance between 2 groups（P〈0.05）. Compared with non-AMI group, LVEDD was higher and LVEF was lower in AMI group（P〈0.05）, and detection rate of f QRS was higher in AMI group than that in non-AMI group（65.48% vs. 34.49%, P〈0.05）. The rate of multi-vessel lesion was significantly higher in group A（93.94%） than that in group B（68.18%） and group C（27.59%, P〈0.05）, and that was significantly higher in group B（68.18%） than that in group C（27.59%, P〈0.05）. The rate of total occlusion was significantly higher in group A（48.18%） than that in group B（13.64%） and group C（3.45%, all P〈0.05）. The difference in rate of total occlusion had no statistical significance between group B（13.64%） and group C（3.45%, P〈0.05）. Conclusion The incidence of f QRS increases and heart function decreases and they are related to disease degree in AMI patients.