QRS波群对急性前壁心肌梗死病人心源性猝死风险的预测价值分析

Value of the QRS wave in the prediction of the risk of sudden cardiac death in patients with acute anterior wall myocardial infarction

目的:分析QRS波群对急性前壁心肌梗死病人心源性猝死风险的预测价值。方法:将98例急性前壁心肌梗死病人作为研究对象,分为早期复极(ER)阴性组和阳性组,各49例。分析病人ER图形特点、形态等,比较2组心室颤动、室性心动过速和死亡等发生率。结果:阳性组QRS时限[(97.96±7.23)min]较阴性组[(89.07±7.93)min]明显延长(P<0.01),心率[(68.05±10.32)次/分]较阴性组[(77.98±6.90)次/分]明显减慢(P<0.01),QTc间期[(424.05±39.68)ms]较阴性组[(459.04±31.24)ms]缩短(P<0.01);但2组病人QT间期、PR间期差异均无统计学意义(P>0.05)。阳性组病人ER图形多处于下壁、下壁加胸前导联,以切迹为主要表现,且ST段多为水平型抬高。阳性组三酰甘油、血钾水平较阴性组明显升高(P<0.01),心室颤动、室性心动过速和死亡率亦明显高于阴性组(P<0.01)。结论:相比无ER的急性前壁心肌梗死病人,伴有ER者心电图QRS时限延长、QTc间期缩短、心率减缓,心室颤动、室性心动过速的发生率明显升高,且发生死亡的风险明显提高。

Objective: To analyze the predictive value of QRS wave in the risk of sudden cardiac death in patients with acute anterior wall myocardial infarction.Methods: Ninety-eight patients with acute anterior myocardial infarction were divided into the early repolarization( ER) negative group and positive group ( 49 cases each group ).The characteristics and morphology of the early repolarization pattern( ERP) in two groups were analyzed,and the incidence rates of ventricular fibrillation,ventricular tachycardia and death between two groups were compared.Results: The time limit of QRS in positive group[( 97.96 ± 7.23) min] was significantly longer than that in negative group[( 89.07 ± 7.93) min]( P < 0.01),the heart rate in positive group[( 68.05 ± 10.32) times/min] was significantly slower than that in negative group[( 77.98 ± 6.90) times/min]( P < 0.01),and the OTc interval time in positive group[( 424.05 ± 39.68) ms]was significantly shorter than that in negative group[( 459.04 ± 31.24) ms]( P < 0.01).The differences of the QT and PR interval time between two groups were not statistically significant( P > 0.05).In the positive group,the ERP mostly located in the lower wall,lower wall and precordial lead;the main manifestation of which located the incisor;and the ST segment was mostly horizontal elevation.The levels of triglyceride and potassium in positive group were significantly higher than those in negative group( P < 0.01 ),and the incidence rates of ventricular fibrillation,ventricular tachycardia and death in positive group were significantly higher than those in negative group ( P < 0.01).Conclusions: Compared with the acute anterior myocardial infarction patients without ER,the QRS duration of electrocardiogram prolongs,the QTc interval shortens,the heart rate decreases,the incidence rates of ventricular fibrillation and ventricular tachycardia increase significantly,and the risk of death increases significantly in the patients with ER.