QRS波时限在下壁心肌梗死中的临床意义
Clinical significance of QRS wave in acute inferior myocardial infarction
- 临床心电学杂志 2022年第3期 页码：172-177
- 作者机构：
1. 山西省心血管病医院
2. 河南省新乡市中心医院
- 作者简介：
- 基金信息：
DOI：
中图分类号： R542.22-
纸质出版：2022
- 稿件说明：
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武海燕, 郑晓斌, 张昭福. QRS波时限在下壁心肌梗死中的临床意义[J]. 临床心电学杂志, 2022,(3):172-177.
Wu hai Yan, Zheng xiaobin, Zhang zhaofu. Clinical significance of QRS wave in acute inferior myocardial infarction[J]. 2022, (3): 172-177.
摘要
目的 研究急性下壁ST段抬高型心肌梗死（STEMI）患者QRS时限延长的临床意义。方法 选择189例确诊并行冠脉造影的下壁STEMI患者，按照心电图QRS波持续时间分为低时限组（QRSd≤95ms
n=78）、中间时限组（95ms<QRSd≤105ms
n=62）、高时限组（QRSd>105ms
n=49），比较3组患者一般资料、左心功能、冠状动脉病变情况及院内预后。结果 高时限组较低时限组陈旧脑梗死比例、空腹血糖显著增高（p<0.01），高时限组高血压和陈旧脑梗死比例多于中间时限组（p<0.05），糖尿病比例在低时限组最少（p<0.05）。右束支阻滞、a VR或V4R导联ST段抬高、右冠脉近段为罪犯血管等占比在高时限组最高，与低时限组比较，高时限组双支闭塞比例高（均p<0.05）。随QRS时限延长，心肌肌钙蛋白（c TNI）、肌酸激酶同工酶（CK-MB）、N末端B型脑钠肽前体（NT-pro BNP）逐渐升高，收缩压、舒张压逐渐降低，但未达到统计学差异（均p>0.05）。与高时限组相比，低时限组左室射血分数（LVEF）、心功能Killip I级占比显著增高，而Killip IV级与心源性休克占比显著减少（均p<0.01），且LVEF≤0.4占比均较中间、高时限组低（p<0.05）。高时限组休克、死亡比例较多，与低时限组比较有统计学差异（p<0.05）。Spearman相关分析显示，QRS时限与LVEF呈负相关，与空腹血糖、双支闭塞、NT-pro BNP、心功能Killip分级、心源性休克、死亡呈正相关（均p<0.05），但相关性均较弱。结论 心电图QRS波时限可以反映下壁心肌梗死患者左心功能情况，QRS时限越长，左室射血分数越低，预后越差。
Abstract
Objective To study the clinical significance of QRS duration prolongation in patients with acute inferior ST segment elevation myocardial infarction（STEMI）. Methods One hundred and eighty-nine patients with inferior STEMI confirmed diagnosis by coronary angiography were divided into low duration group（QRS duration≤95ms
n=78）
intermediate duration group（95ms0.05）. Compared with the high duration group
the left ventricular ejection fraction（LVEF） and the proportion of Killip I were significantly higher in the low duration group
while the latter has the significantly lower proportion of Killip IV and cardiogenic shock（all p<0.05）
and its proportion of EF≤0.4 was lower than that of the intermediate and high duration group（p<0.05）. The high duration group had more shock and deaths rate than the low duration group（p<0.05）. QRS duration was negatively correlated with EF
and positively correlated with fasting blood glucose
double-vessel occlusion
NT-pro BNP
cardiac function Killip classification
cardiogenic shock
and death（all p<0.05）
but the correlation was weak. Spearman correlation analysis showed that QRS duration was negatively correlated with EF
and positively correlated with fasting blood glucose
double-vessel occlusion
NT-pro BNP
cardiac function Killip classification
cardiogenic shock and death（all p<0.05）
but the correlation was weak. Conclusions The QRS wave duration of electrocardiograph can reflect the left ventricular function of patients with inferior myocardial infarction.The longer of the QRS duration
the lower of the LVEF and the worse of the prognosis follows.
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references
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