急性心肌梗死患者心电图有无碎裂QRS波在急诊PCI术后住院期间的预后区别研究

Prognostic Difference of Electrocardiogram with or Without Fragmented QRS Wave in Patients with Acute Myocardial Infarction during Hospitalization after Emergency PCI

目的探讨急性心肌梗死患者心电图有无碎裂QRS波在急诊PCI术后住院期间的预后区别。方法回顾性分析2017年4月至2018年6月我院收治的AMI并行急诊PCI术的218例患者的临床资料,根据是否存在碎裂QRS(fQRS)波分为有碎裂QRS波组(129例)及无碎裂QRS波组(89例)。分析有碎裂QRS波组患者fQRS导联出现的位置。对比两组患者入院72 h的相关临床指标,住院天数、病变数目及支架数量,住院期间不良事件发生情况。结果有碎裂QRS波组患者fQRS波出现在Ⅱ、Ⅲ、avF导联占89.15%,其余为Ⅲ、avF导联(13.95%),Ⅰ、avF导联(27.13%),V4~V6导联(45.56%)。有碎裂QRS波组的BS,TG,BNP,TnT,CK峰值,CKMB峰值明显高于无碎裂QRS波组,差异具有统计学意义(P<0.05),两组的LDL相比,差异无统计学意义(P>0.05)。有碎裂QRS波组患者的住院天数与支架数量明显高于无碎裂QRS波组,差异对比显著(P<0.05),但两组患者的单支病变,双支病变,三支病变数目对比差异无显著(P>0.05)。有碎裂QRS波组恶性心律失常发生例数明显高于无碎裂QRS波组(P<0.05),而两组的脑血管意外、心源性休克、低血压、心源性猝死发生情况对比无差异(P>0.05)。结论碎裂QRS波作为一种无创心电指标,对患者预后的改善具有重要意义,也可为治疗策略的选择提供参考。

Objective To explore the prognostic difference of electrocardiogram with or without fragmented QRS wave in patients with acute myocardial infarction during hospitalization after emergency PCI.Methods The clinical data of 218 patients with AMI and emergency PCI in our hospital from April 2017 to June 2018 were retrospectively analyzed.According to whether there is fragmentary QRS(fQRS)or not,they were divided into two groups:fragmentary QRS group(129 cases)and non fragmentary QRS group(89 cases).To analyze the location of fQRS leads in patients with fragmented QRS waves.The clinical indexes,length of stay,number of lesions and stents,and adverse events during hospitalization were compared between the two groups.Results In the group with fragmented QRS,the frequency of fQRS was 89.15%inⅡ,Ⅲ,avF,Ⅲ,avF was 13.95%,Ⅰ,avF was 27.13%,V4-V6 was 45.56%.The BS,TG,BNP,TNT,CK peak and CKMB peak in the QRS group with fragmentation were significantly higher than those in the QRS group without fragmentation,the difference is statistically significant(P<0.05),there was no significant difference in LDL between the two groups(P>0.05).The length of stay and the number of stents in the QRS group with fragmentation were significantly higher than those in the QRS group without fragmentation(P<0.05),however,there was no significant difference in the number of single branch,double branch and three branch lesions between the two groups(P>0.05).The incidence of malignant arrhythmia in the QRS group with fragmentation was significantly higher than that in the QRS group without fragmentation(P<0.05),but there was no difference in the incidence of cerebrovascular accident,cardiogenic shock,hypotension and sudden cardiac death between the two groups(P>0.05).Conclusion As a noninvasive electrocardiographic index,fragmentary QRS has great significance to improve the prognosis of patients,and also can provide reference for the choice of treatment.