Poincare散点图联合心电图QRS碎裂波诊断心肌梗死的临床研究

Clinical study on the diagnosis of myocardial infarction by Poincare scatter pattern combined with ECG QRS fragmentation

目的观察Poincare散点图联合心电图QRS碎裂波（fQRS）在心肌梗死诊断中的应用价值。方法选择我院2015年1月至2017年5月确诊为心肌梗死的患者184例，其中急性心肌梗死（AMI）患者94例、陈旧性心肌梗死（OMI）患者90例。根据12导联心电图QRS波形态分为fQRS波组（106例）及无fQRS波组（78例）。根据Poincare散点图形状将fQRs波组患者分为非彗星状组（A组）和彗星状组（B组），以及无fQRS波组（C组）。均以冠状动脉造影术诊断结果为诊断“金标准”，分析各组冠状动脉造影结果，进行组间比较。结果冠状动脉造影结果显示，A组冠状动脉单支病变4例（6．7％），多支病变56例（93．3％）；B组冠状动脉单支病变11例（19．64％），多支病变45例（80．36％）；C组冠状动脉单支病变50例（64．10％），多支病变28例（35．90％）；其中B、C组多支病变百分比较A组小，差异有统计学意义（P〈0．05）。A组中的完全闭塞发生率（56．67％）显著高于B组（21．43％）和C组（20．56％），差异均有统计学意义（P〈0．05）。结论Poincare散点图联合心电图QRS碎裂波形检查诊断急性心肌梗死伴冠状动脉完全闭塞发生率明显高于Poincare散点图正常合并fQRS波形及无fQRS波形，两项指标联合应用对高危心肌梗死预警有一定临床意义。Poincare散点图联合心电图QRS碎裂波形检查均为无创性检查，安全性好，值得临床推广。

Objective To observe the value of Poincare scatter plot combined with electrocardiogram QRS cleavage （fQRS） in the diagnosis of myocardial infarction. Methods Forty-eight patients with acute myocardial infarction （AMI） were enrolled in our hospital from January 2015 to May 2017, 40 patients with acute myocardial infarction（OMI ）（68 cases） and no fQRS wave group（ 16 cases）. The patients in the fQRS group were divided into non-comet group （group A） according to the Poincare scatter plot, And comet - like group （group B）, no fQRS group（group C ）. Coronary angiography was used to diagnose the ＂gold standard＂, the results of coronary angiogra- phy were analyzed and compared between groups. Results Coronary angiography showed that in group A, 4 cases （6.7%） had coronary artery single vessel disease and 56 eases （93.3%） had multi-vessel disease. In group B, 11 cases（19.64%） had coronary artery single vessel disease, 45 cases（80.36%）. In group C, 50 cases（64.10%） had coronary artery single vessel disease and 28 cases （35.90%） had multi-vessel disease. The percentage of multi- vessel disease in group B and C was smaller than that in group A （P〈0.05）. The complete occlusion rate in group A （56.67%） was significantly higher than that in group B（21.43% ） and group C （20.56%）（P〈0.05 ）. Conclusion The complete occlusion of coronary artery in acute myocardial infarction are significantly higher in Poincare scatter plot combined with fQRS than that of Poincare scatter plots. The fQRS waveforms and fQRS waveforms not combined with Poincare scatterplot combined with electrocardiogram. The two indexes were combined with high risk myocardial infarction Early warning has a certain clinical significance.