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《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:

2017年第3期

页码:

297-299,321

栏目:

临床研究

出版日期:

2017-01-25

文章信息/Info

Title:

Diagnostic and prognostic value of fragmented QRS complex in patients with non-ST-elevation myocardial infarction

作者:

吴兴安¹; 3; 李秀琪¹; 谢 刚¹; 余 稳¹; 韩 静¹; 吴 薇²; 王 祥³

长江航运总医院、武汉脑科医院：1.心血管内科，2.心电图室，湖北 武汉 430010；3.华中科技大学同济医学院附属协和医院心内科，湖北 武汉 430022

Author(s):

WU Xing-an¹; 3;  LI Xiu-qi¹;  XIE Gang¹;  YU Wen¹;  HAN Jing¹;  WU Wei²;  WANG Xiang³

1.Department of Cardiology, 2.Department of Electrocardiogram, Wuhan Brain Hospital & General Hospital of Yangtze River Shipping, Wuhan 430010, Hubei, China; 3.Department of Cardiology, Union Hospital, Huazhong University of Science and Technology, Wuhan

关键词:

碎裂QRS波群; 非ST段抬高型急性心肌梗死; 诊断; 预后

Keywords:

fragmented QRS complex;  non-ST-elevated myocardial infarction;  diagnosis;  prognosis

分类号:

R541.4

DOI:

-

文献标识码:

A

摘要:

目的 探讨静息12导联心电图碎裂QRS波群（fragmented QRS complex,fQRS）对非ST段抬高型急性心肌梗死（non-ST elevated myocardial infarction,NSTEMI）的诊断和预后判断的临床价值。方法 分析了长江航运总医院心内科2012~2014年所有确诊为NSTEMI的患者，并将所有患者的临床特点、实验室检查、12导联心电图、心脏肌钙蛋白I(cTnI)、超声心动图及冠状动脉造影等进行统计分析。在286例符合入选标准的NSTEMI患者中，根据入院72 h内静息12导联心电图表现分为fQRS波者85例、病理性Q波者62例、fQRS波并发病理性Q波者103例，另外有36例为单纯ST-T改变，对比分析fQRS波群与病理性Q波在NSTEMI患者中的发生率，同时对这些患者进行1年随访，观察其室性心律失常、心力衰竭、心脏性死亡发生情况。结果 在NSTEMI患者中，fQRS波群、病理性Q波诊断NSTEMI的灵敏度，分别为65.7%、57.7%,fQRS波灵敏度高于病理性Q波（P<0.05）；两者平行试验诊断NSTEMI的灵敏度为87.4%，显著高于单纯fQRS波和病理性Q波（均P<0.01）。1年随访期间，fQRS波阳性组室性心律失常、心力衰竭及心脏性死亡的发生率均显著高于fQRS波阴性组（均P<0.05），特别是室性心律失常发生率尤为显著。结论 在NSTEMI患者中，fQRS波是心电图检查中一个有力的诊断线索，同时也是预测短期心脏性事件的可靠标志。

Abstract:

AIM To investigate the diagnostic and prognostic value of fragmented QRS (fQRS) complex in patients with non-ST-elevated myocardial infarction (NSTEMI). METHODSWe analyzed the clinical characteristics and results of laboratory examination, 12-lead electrocardiogram (ECG), cardiac troponin I (cTnI), ultrasound cardiogram (UCG) and coronary angiography (CAG) in 286 patients with confirmed NSTEMI in our hospital from January 2012 to April 2014. According to the results of resting 12-lead ECG within 72 h of hospitalization, 85 patients had fQRS complex, 62 pathologic Q-wave, 103 fQRS complex combined with pathologic Q-wave and 36 with only ST-T changes. We studied the incidence rate, sensitivity of fQRS complex and pathologic Q-wave in these NSTEMI patients. All patients were followed for 1 year to observe the incidence of cardiac events. RESULTSFor NSTEMI diagnosis, the sensitivity in fQRS complex was higher than in pathologic Q-wave (65.7% vs. 57.7%, P<0.05). Sensitivity in the parallel test was 87.4%, significantly higher than in fQRS complex or pathologic Q-wave (P<0.01). Cardiac events of fQRS(+) group were significantly higher than those of fQRS(-) group after 1 year follow-up. CONCLUSIONfQRS complex is a good diagnostic clue in ECG for NSTEMI and is a reliable indicator for short-term cardiac events in NSTEMI patients.

参考文献/References

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备注/Memo

备注/Memo:

收稿日期：2016-03-07.通讯作者：李秀琪，副主任医师，主要从事心血管内科疾病研究Email:lixiuqi0604@163.com 共同通讯作者：王祥，主任医师，主要从事心血管疾病介入治疗和急危重症救治 Email:wxiang128@163.com 作者简介：吴兴安，硕士生 Email:wu_xingan@163.com

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更新日期/Last Update: 2017-02-20