QRS终末扭曲对急性ST段抬高型心肌梗死患者病情及预后的评估价值

The value of QRS terminal distortion in the assessment of the condition and prognosis of patients with acute ST-segment elevation myocardial infarction

目的探讨QRS终末扭曲对急性ST段抬高型心肌梗死(STEMI)患者病情及预后的评估价值。方法选择2016年6月至2017年6月于湖北省第三人民医院心功能科收治的STEMI患者139例为研究对象,按心电图特征将患者分为QRS终末扭曲组(n=61)、非QRS终末扭曲组(n=78),对两组患者的一般临床资料(性别、年龄、合并症、心肌梗死位置、病程、溶栓治疗比例、ST段抬高导联数、QRS积分、心肌酶、肌酸激酶、左室射血分数)以及预后指标(心血管事件发生率、死亡率、Killip心功能分级)进行比较。结果两组患者一般资料比较,在性别、合并症、心肌梗死位置、溶栓治疗比例、ST段抬高导联数目等方面无显著差异(P>0.05)。QRS终末扭曲组患者年龄、病程、QRS积分、心肌酶和肌酸激酶水平均高于非QRS终末扭曲组,而左室射血分数低于非QRS终末扭曲组(P<0.05)。QRS终末扭曲组患者的不良心血管事件发生率和死亡率均高于非QRS终末扭曲组,Killip心功能Ⅲ级和Ⅳ级患者比例高于非QRS终末扭曲组,差异有统计学意义(P<0.05)。结论通过评估STEMI患者QRS波形扭曲程度,可实现对STEMI患者的病情及预后效果的判断。

Objective To investigate the value of terminal distortion of QRS in evaluating the condition and prognosis of patients with acute ST segment elevation myocardial infarction(STEMI). Methods 139 patients with STEMI in Cardiac function department,The Third People’s Hospital of Hubei province in June 2016~2017 were selected as the subjects. The patients were divided into QRS terminal distortion group(n=61) and non QRS terminal distortion group(n=78) according to the characteristics of the patients’ electrocardiogram. The general clinical data(gender, age, complications, location of myocardial infarction, course of disease, proportion of thrombolytic therapy, ST elevation leads, QRS score, myocardial enzymes, creatine kinase, left ventricular ejection fraction), prognostic indicators(incidence of cardiovascular events, mortality, Killip cardiac function classification) was evaluated and compared between the two groups. Results There was no significant difference in gender, complication, myocardial infarction, thrombolytic therapy and ST elevation lead in the general data of the two groups(P>0.05). The age, the course of the disease, QRS integral, the myocardial enzyme, the creatine kinase level of QRS terminal distortion group was higher than the non QRS end distortion group, and the left ventricular ejection fraction was lower than the non QRS terminal distortion group, and there was a significant difference between the two groups(P<0.05). The incidence of adverse cardiovascular events and the mortality of the patients with QRS terminal distortion were higher than those in the non QRS end warping group. The proportion of III and IV in the Killip cardiac function classification was higher than that of the non QRS terminal distortion group, and the difference between the two groups had the statistical significance(P<0.05). Conclusion The diagnosis, evaluation and prognosis of STEMI patients can be realized by differentiating the degree of distortion of QRS waveform in electrocardiogram.