动态心电图检出心律失常与心肌梗死患者不同冠状动脉病变的关系分析

Relationship between arrhythmia detected by dynamic electrocardiogram and coronary artery lesions of different degrees in patients with myocardial infarction

目的探讨动态心电图检出心律失常与心肌梗死患者不同冠状动脉病变的关系。方法选取接受动态心电图检查和冠状动脉造影检查的200例急性心肌梗死患者作为研究对象,记录患者心律失常发生率;根据冠状动脉造影结果进行分组,分析不同冠状动脉病变支数、病变部位和狭窄程度与心律失常的关系。结果200例急性心肌梗死患者中,房性心律失常137例(68.50%),室性心律失常81例(40.50%);ST段抬高132例(66.00%),ST段降低53例(26.50%),ST段无偏移15例(7.50%)。多支病变组的频发室早发生率高于单支病变组,且Lown3级及以上室性早搏、缓慢心律失常、房性心律失常的发生率高于单支病变组和多支病变组,差异有统计学意义(P<0.05);左主干及前降支组的频发室早、房性心律失常发生率高于右冠状动脉组,Lown3级及以上室性早搏发生率高于左回旋支组和右冠状动脉组,缓慢心律失常发生率低于左回旋支组和右冠状动脉组,差异有统计学意义(P<0.05)。冠状动脉狭窄程度>90%组的ST段抬高发生率高于<70%组和70%~90%组,ST段降低发生率高于70%~90%组,差异有统计学意义(P<0.05)。结论心律失常在急性心肌梗死患者中多发,冠状动脉病变与此密切相关,对动态心电图检出心律失常进行判断有利于预判急性心肌梗死患者的冠状动脉病变情况和预后情况。

Objective To explore the relationship between arrhythmia detected by dynamic electrocardiogram and coronary artery lesions of different degrees in patients with myocardial infarction.Methods A total of 200 patients with acute myocardial infarction who underwent dynamic electrocardiogram and coronary angiography were selected as research objects,their incidence rates of arrhythmia were recorded. According to the results of coronary angiography,they were divided into different groups. The relationships between the number of coronary artery lesions,lesion location as well as stenosis degree and arrhythmia were analyzed. Results Among the 200 patients with acute myocardial infarction,there were 137 patients (68. 50%) with atrial arrhythmia and 81 patients (40. 50%) with ventricular arrhythmia,132 cases (66. 00%) with ST segment elevation,53 cases (26. 50%) with ST segment reduction,and 15 cases (7. 50%) with no ST segment excursion. The incidence of frequent ventricular premature beats in the multiple-vessel lesion group was significantly higher than that in the single-vessel lesion group,and the incidence rates of premature ventricular beats of grade Lown3 and above,bradyarrhythmia,and atrial arrhythmia were significantly higher than that in the single-vessel lesion group and the multiple-vessel lesion group (P < 0. 05). The incidence of frequent ventricular premature beats and atrial arrhythmia in the left main and anterior descending branches group was significantly higher than that in the right coronary artery group,the incidence of ventricular premature beats at grade Lown3 and above was higher than that in the left cyclobrane group and the right coronary artery group,and the incidence of bradyarrhythmia was significantly lower than that in the left cyclobrane group and the right coronary artery group (P < 0. 05). The incidence of ST-segment elevation in the group with stenosis of coronary artery more than 90% was significantly higher than that in the groups with stenosis of coronary artery less than 70% and ranging from 70% to 90%,and the incidence of ST-segment reduction was significantly higher than that in the group with stenosis of coronary artery ranging from 70% to 90% (P < 0. 05). Conclusion Arrhythmia is a frequently occurring disease in patients with acute myocardial infarction,and is closely related to coronary artery disease. The judgment of arrhythmia detected by dynamic electrocardiogram is beneficial to the prediction of coronary artery disease and prognosis of patients with acute myocardial infarction.