QRS波群形态对急性心肌梗死患者心功能和预后的影响.docVIP

QRS波群形态对急性心肌梗死患者心功能和预后的影响 　　作者：王荣英 田英平 张晓雷 李旭蕊 石汉文 郭宪立 作者单位：河北医科大学第二医院急诊科，河北 石家庄 050000 　　【摘要】目的 通过对急性ST段抬高心肌梗死(STEMI)患者入院时心电图QRS波群变化进行缺血分级，探讨缺血分级的临床意义。方法 223例STEMI患者根据入院时心电图QRS波群变化进行缺血分级：2级缺血组(134例)：ST段抬高但QRS波终末部无改变;3级缺血组(89例)：除ST段抬高外，QRS波终末部扭曲且常伴R波增高与S波消失。两组患者在发病12 h内均行溶栓治疗，观察心电图ST段变化;梗死后2 w行99m锝甲氧基异丁基异腈(99mTcMIBI)心肌灌注断层显像(SPECT)和99m锝红细胞(99mTcRBC)心血池显像，测定心肌梗死面积和心功能;统计2组患者住院期间并发症的发生率。结果 入院时和溶栓后2 h，3级缺血组ST段抬高的幅度(∑ST)均显著大于2级缺血组(P0.01)，溶栓后2 h，ST段回降率显著低于2级缺血组(P0.01);3级缺血组肌酸激酶同工酶(CKMB)峰值显著高于2级缺血组(P0.01)，心肌梗死面积大于2级缺血组(P0.05)，左室射血分数低于2级缺血组(P0.05);两组患者严重心律失常、心力衰竭或心源性休克、再梗死的发生率和住院病死率均无显著性差异，但3级缺血组有高于2级缺血组的趋势。结论 入院时心电图呈3级缺血的急性STEMI患者溶栓后易于出现ST段回降不良，导致心肌梗死面积大，心功能和预后差，需要采取更加积极的治疗措施。 　　【关键词】 急性ST段抬高心肌梗死;溶栓治疗;心功能;预后 　　Effects of admission QRS complex on ventricular function and prognosis in patients with acute myocardial infarction 　　WANG RongYing, TIAN YingPing, ZHANG XiaoLei, et al. 　　Department of Emergency, the Second Affiliated Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei, China 　　【Abstract】 Objective To investigate clinical significance of the grade of ischemia by QRS complex on the admission electrocardiogram (ECG) in patients with acute STsegment elevation myocardial infarction (STEMI). Methods 223 patients wi 　　th acute STEMI who received thrombolytic therapy, were divided into two groups based on the enrollment electrocardiogram: grade 2 ischemia (ST elevation without terminal QRS distortion; n=134) and grade 3 ischemia (ST elevation with termina 　　l QRS distortion; n=89). 99mTcMIBI SPECT was performed to detect myocardial infarction area(MIA); 99mTc gated cardiac blood pool image was performed to measure ventricular function. The incidence rate of ST segment resolution (STR), and complications in hospital stay were observed. Results ①Patients with grade 3 ischemia had greater ST on admission and 2 h after thrombolysis ECGs (P0.01), the incidence rate of STR in patients with grade 3 ischemia was lower than t