中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
19期
13-16
,共4页
心肌梗死%猝死,心脏%QRS波时限%QTc间期%左心室射血分数
心肌梗死%猝死,心髒%QRS波時限%QTc間期%左心室射血分數
심기경사%졸사,심장%QRS파시한%QTc간기%좌심실사혈분수
Myocardial infarction%Death,sudden,cardiac%Duration of QRS wave%QTc interval%Left ventricular ejection fraction
目的 探讨急性心肌梗死后早期心电图QRS波增宽预测远期心脏性猝死(SCD)发生的价值.方法 选择259例急性心肌梗死后存活患者,在早期(≤30 d)采用超声测定左心室射血分数(LVEF),体表心电图测定QRS波时限和QTc间期,临床随访观察(16.5±3.8)个月发生的SCD事件.根据随访结果将患者分为SCD组和存活组.结果 随访期内8.1％(21/259)患者发生SCD.与存活组患者比较,SCD组患者的LVEF明显降低[(35.8±8.2)％比(53.3±6.0)％],差异有统计学意义(P=0.016),QRS波明显增宽[(118.8±15.2) ms比(91.5±13.6) ms],差异有统计学意义(P=0.023),而两组患者QTc间期比较差异无统计学意义(P=0.184).LVEF降低、QRS波增宽和QTc间期延长预测SCD的灵敏度依次为42.9％(9/21)、66.7％(14/21)和38.1％(8/21).多元Logistic回归分析显示,院前电复律/除颤史(RR=6.514,P=0.011)、LVEF降低(RR=7.325,P=0.005)和QRS波增宽(RR=4.023,P=0.024)为SCD发生的独立危险因素.结论 急性心肌梗死后早期QRS波增宽能独立预测远期SCD的发生.
目的 探討急性心肌梗死後早期心電圖QRS波增寬預測遠期心髒性猝死(SCD)髮生的價值.方法 選擇259例急性心肌梗死後存活患者,在早期(≤30 d)採用超聲測定左心室射血分數(LVEF),體錶心電圖測定QRS波時限和QTc間期,臨床隨訪觀察(16.5±3.8)箇月髮生的SCD事件.根據隨訪結果將患者分為SCD組和存活組.結果 隨訪期內8.1％(21/259)患者髮生SCD.與存活組患者比較,SCD組患者的LVEF明顯降低[(35.8±8.2)％比(53.3±6.0)％],差異有統計學意義(P=0.016),QRS波明顯增寬[(118.8±15.2) ms比(91.5±13.6) ms],差異有統計學意義(P=0.023),而兩組患者QTc間期比較差異無統計學意義(P=0.184).LVEF降低、QRS波增寬和QTc間期延長預測SCD的靈敏度依次為42.9％(9/21)、66.7％(14/21)和38.1％(8/21).多元Logistic迴歸分析顯示,院前電複律/除顫史(RR=6.514,P=0.011)、LVEF降低(RR=7.325,P=0.005)和QRS波增寬(RR=4.023,P=0.024)為SCD髮生的獨立危險因素.結論 急性心肌梗死後早期QRS波增寬能獨立預測遠期SCD的髮生.
목적 탐토급성심기경사후조기심전도QRS파증관예측원기심장성졸사(SCD)발생적개치.방법 선택259례급성심기경사후존활환자,재조기(≤30 d)채용초성측정좌심실사혈분수(LVEF),체표심전도측정QRS파시한화QTc간기,림상수방관찰(16.5±3.8)개월발생적SCD사건.근거수방결과장환자분위SCD조화존활조.결과 수방기내8.1％(21/259)환자발생SCD.여존활조환자비교,SCD조환자적LVEF명현강저[(35.8±8.2)％비(53.3±6.0)％],차이유통계학의의(P=0.016),QRS파명현증관[(118.8±15.2) ms비(91.5±13.6) ms],차이유통계학의의(P=0.023),이량조환자QTc간기비교차이무통계학의의(P=0.184).LVEF강저、QRS파증관화QTc간기연장예측SCD적령민도의차위42.9％(9/21)、66.7％(14/21)화38.1％(8/21).다원Logistic회귀분석현시,원전전복률/제전사(RR=6.514,P=0.011)、LVEF강저(RR=7.325,P=0.005)화QRS파증관(RR=4.023,P=0.024)위SCD발생적독립위험인소.결론 급성심기경사후조기QRS파증관능독립예측원기SCD적발생.
Objective To investigate the predictive value of QRS wave widen on the incidence of long-term sudden cardiac death (SCD) during the early phase after acute myocardial infarction (AMI).Methods Two hundred and fifty-nine survived patients with AMI were enrolled.The left ventricular ejection fraction (LVEF) was measured by echocardiography,and the QRS duration and the QTc interval were measured automatically by electrocardiography during the early phase (≤30 d) after AMI.The time of follow-up was (16.5 ± 3.8) months,and the incidence of SCD was observed.The patients were divided into SCD group and survived group according to the follow-up outcome.Results The incidence rate of SCD was 8.1％(21/259).The LVEF in SCD group was significantly lower than that in survived group [(35.8 ± 8.2)％vs.(53.3 ± 6.0)％],and there was statistical difference (P =0.016).The QRS duration was significantly wider than that in survived group [(118.8 ± 15.2) ms vs.(91.5 ± 13.6) ms],and there was statistical difference (P =0.023).There was no statistical difference in QTc interval between the 2 groups (P =0.184).In SCD group,the percentage of patients with decreased LVEF,widen QRS wave and QTc interval prolongation was 42.9％ (9/21),66.7％ (14/21) and 38.1％ (8/21),respectively.The multielement Logistic regression analysis result showed that prehospital electrical conversion/defibrillate (RR =6.514,P =0.011),LVEF decreased (RR =7.325,P =0.005) and QRS wave widen (RR =4.023,P =0.024) were the independent risk factors of SCD.Conclusion QRS wave widen is an independent risk factor for SCD in patients with AMI.
