CAJ | 학술논문

目的：探讨碎裂 QRS 波在急性 ST 段抬高型心肌梗死中的临床价值。方法回顾分析经急诊介入术的急性 ST 段抬高型心肌梗死362例，根据入院时是否存在 fQRS 波分为 fQRS 组和 N-fQRS 组，通过观察临床资料、冠状动脉造影、超声心动图以及住院期间心脏事件发生率，对比2组间的差异。结果362例患者 fQRS 组132例，N-fQRS 组230例，fQRS 发生率36.46%，fQRS组较 N-fQRS 组心肌酶升高、发病到入院时间延长，差异有统计学意义（P＜0.05）；冠状动脉造影提示 fQRS 组比 N-fQRS 组更多见前降支、多支血管病变者（53.8% vs 38.7%，50.8% vs 33.9%，P＜0.05）；超声心动图显示左心室射血分数更低（P=0.001），左心室室壁瘤（P=0.001）和住院期间恶心心律失常发生率增高（P＜0.05），心功能 Killip 3～4级发生率高（P=0.001），但心源性死亡两组未见异常（P=0.132）。结论 fQRS 波可以协助判断急性 ST 段抬高型心肌梗死血管病变以及心功能、恶性心律失常发生，可作为预测住院期期预后的一个心电学指标。
목적：탐토쇄렬 QRS 파재급성 ST 단태고형심기경사중적림상개치。방법회고분석경급진개입술적급성 ST 단태고형심기경사362례，근거입원시시부존재 fQRS 파분위 fQRS 조화 N-fQRS 조，통과관찰림상자료、관상동맥조영、초성심동도이급주원기간심장사건발생솔，대비2조간적차이。결과362례환자 fQRS 조132례，N-fQRS 조230례，fQRS 발생솔36.46%，fQRS조교 N-fQRS 조심기매승고、발병도입원시간연장，차이유통계학의의（P＜0.05）；관상동맥조영제시 fQRS 조비 N-fQRS 조경다견전강지、다지혈관병변자（53.8% vs 38.7%，50.8% vs 33.9%，P＜0.05）；초성심동도현시좌심실사혈분수경저（P=0.001），좌심실실벽류（P=0.001）화주원기간악심심률실상발생솔증고（P＜0.05），심공능 Killip 3～4급발생솔고（P=0.001），단심원성사망량조미견이상（P=0.132）。결론 fQRS 파가이협조판단급성 ST 단태고형심기경사혈관병변이급심공능、악성심률실상발생，가작위예측주원기기예후적일개심전학지표。
Objective To explore the clinical value of fragmented QRS complexes (fQRS) for the disease of acute ST segment elevation myocardial infarction (STEMI). Methods This was a retrospective analysis of 362 patients who underwent emergency percutaneous coronary intervention (PCI). We divided the patients into two groups, fQRS and N-fQRS group, according to their electrocardiograms (ECG) during on admission. Comparatively statistical analyses were made on the data including clinical indexes, coronary angiogram, echocardiography and the incidence of major adverse cardiac events (MACE). Results 132 cases were in fQRS group and 230 cases were in N-fQRS group. The incidence of fQRS was 36.46%. Patients of fQRS group usually had higher morbidity of LAD infarction and multi-vessel disease (53.8% vs 38.7%, 50.8% vs 33.9%, P<0.05). The fQRS group had higher CK-MB levels (P<0.05). The time from occurrence to on admission was also longer for the fQRS group (P<0.05). There were also lower left ventricular ejection fraction (P=0.001), more incidence of ventricular aneurysm (P=0.001), malignant arrhythmia (P<0.05) and higher heart function Killip Ⅲ-Ⅳ incidence (P=0.001) during hospitalization for the fQRS group. Cardiovascular death showed no significant difference between two groups (P=0.132). Conclusion The occurrence of fQRS can be a taken as a electro cardiology index to value the risk of maculopathy, heart function and malignant arrhythmia for acute STEMI patients during hospitalization.