下侧壁导联QRS间期延长与急性肺栓塞近期预后的关系研究

The relation between prolonged QRS duration in inferior and lateral leads and short-term outcomes of acute pulmonaryembolism

目的探讨下侧壁导联QRS间期延长与急性肺栓塞(APE)近期预后的关系。方法选择2021年1月至2022年6月在瑞安市人民医院就诊,经肺CT血管造影确诊为APE的患者101例。根据下侧壁导联QRS间期,将患者分为QRS间期≥100ms组42例和QRS间期<100ms组59例。收集两组患者的既往史、入院时的实验室检查、心电图和超声心动图检查结果。采用Cox回归风险模型分析APE发病30d内死亡的影响因素。结果QRS间期≥100 ms组的慢性肺病占比高于QRS间期<100ms组,差异有统计学意义(P<0.05)。QRS间期≥100 ms组的心脏骤停,晕厥,中高危、高危患者占比,心肌肌钙蛋白I(cTnI),30 d死亡率高于QRS间期<100 ms组,血氧饱和度低于QRS间期<100 ms组,差异均有统计学意义(均P<0.05)。单因素Cox回归分析显示,心力衰竭、慢性肺病、心脏骤停、高危、QRS间期≥100ms与APE发病30d内死亡相关(均P<0.05)。Cox多因素回归分析显示,心力衰竭、QRS间期≥100ms对APE发病30 d内死亡均有独立预测价值(均P<0.05)。结论下壁与侧壁QRS间期延长的APE患者30d死亡率较高。

Objective To investigate the relationship between prolonged QRS duration in inferior and lateral leads and short-term outcomes of patients with acute pulmonary embolism(APE).Methods A total of 101 patients with APE diagnosed by pulmonary CT angiography in Ruian People's Hospital from January 2021 to June 2022 were included.According to QRS duration in inferior and lateral leads,the patients were divided into QRS duration≥100ms group(n=42)and QRS duration<100 ms group(n=59).The past medical history,the results of laboratory examination,electrocardiogram and echocardiography at admission were collected.Cox proportional hazards model was used to analyze influencing factors of death within 30 days after APE.Results The percentage of patients with chronic lung disease was significantly higher in QRS duration≥100 ms group than in QRS duration<100 ms group(P<0.05).The proportion of cardiac arrest,syncope,medium to high risk,and high-risk patients,cTnI,and mortality within 30 days in the QRS duration≥100 ms group were higher than those in the QRS duration<100 ms group,and SpO2 was lower than that in the QRS duration<100 ms group(all P<0.05).Cox univariate analysis showed that heart failure,chronic lung disease,cardiac arrest,high-risk,QRS duration≥100 ms were associated with death within 30 days after APE(all P<0.05).Cox multivariate analysis showed that heart failure and QRS duration≥100 ms were independent predictive factors for the death of APE within 30 days(all P<0.05).Conclusion APE patients with prolonged QRS duration in inferior and lateral leads have higher mortality rate with 30 days.