QRS波群形态对急性心肌梗死患者心功能与预后的影响.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:___________单位: ___________邮编: ___________） 作者：王荣英 田英平 张晓雷 李旭蕊 石汉文 郭宪立 【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 　　【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 (P＜0.01), the incidence rate of STR in patients with grade 3 ischemia was lower than that in patients with grade 2 ischemia (P0.01). ② The peak creatine kinase MB fraction was higher, MIA was greater, and left ventricular eject fraction was lower in patients with grade 3 ischemia than those in patients with grade 2 ischemia (P＜0.01; P＜0.05). ③There was no significant difference of the