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碎裂QRS波群对非ST段抬高型急性心肌梗死的诊断和预后判断的临床价值(PDF)

《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13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-an13 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.

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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
更新日期/Last Update: 2017-02-20