临床和实验医学杂志
臨床和實驗醫學雜誌
림상화실험의학잡지
Journal of Clinical and Experimental Medicine
2015年
18期
1515-1518
,共4页
徐亮%赵祥海%季燕妮%吴宜鸣
徐亮%趙祥海%季燕妮%吳宜鳴
서량%조상해%계연니%오의명
急性心肌梗死%心脏性猝死%QRS波%射血分数%预测价值
急性心肌梗死%心髒性猝死%QRS波%射血分數%預測價值
급성심기경사%심장성졸사%QRS파%사혈분수%예측개치
Acute myocardial infarction%Sudden cardiac death%QRS wave%Ejection fraction%Predictive value
目的：探究急性心肌梗死患者利用左心室射血分数（LVEF）及 QRS 波对心脏性猝死（SCD）事件的预测效能，并为这类疾病早期干预提供支撑。方法回顾性分析于2010年7月至2013年4月收治的106例急性心肌梗死患者资料，对其追踪随访10个月，根据患者是否存活进行分组，分别设为存活组和 SCD 组。利用超声心动图测定 LVEF、体表心电图测定 QRS 波长及 QTc 间期数据。结果存活者为93例（87.7%），SCD 为13例（12.3%）。SCD 组患者院外除颤率高于存活组（ P ﹤0.05），院内接受介入治疗、药物保守治疗、吸烟及高血脂率高于存活组（ P ﹤0.05）。两组患者在性别构成比、年龄、体质指数、高血压、糖尿病、梗死部位等方面差异无统计学意义（ P ﹥0.05）。存活组 QRS 波宽度为（103.2±4.2）ms，小于 SCD 组（116.3±5.8）ms，差异有统计学意义（ P ﹤0.05）；存活组 LVEF 值为（52.9±3.1）%，高于 SCD 组（34.8±2.7）ms，差异有统计学意义（ P ﹤0.05）；两组 QTc 间期差异无统计学意义（ P ﹥0.05）。LVEF 预测急性心肌梗死后 SCD 的敏感度为39.2%，特异度为92.7%，真阳性率71.3%；QRS 波预测的敏感度为65.4%，特异度为66.7%，真阳性率63.2%；LVEF 联合 QRS 诊断的敏感度89.3%，特异度91.5%，真阳性率87.5%。LVEF 降低（25.9%vs.3.2%，P ﹤0.05）和 QRS 波增宽（9.5% vs.2.4%，P ﹤0.05）的患者远期 SCD 发生率较高。院外除颤[RR ＝5.9，95% CI（1.6~23.4），P ﹤0.05]、LVEF 降低[RR ＝7.1，95% CI（1.9~24.3），P ﹤0.05]及 QRS 波增宽[RR ＝3.5，95%CI（1.1~12.6），P ﹤0.05]均可作为 SCD 危险因素，具有一定的预测价值。结论 QRS 波及 LVEF 联合检测能提高急性心肌梗死后 SCD 的诊断效能，患者及医生应重视上述两项指标的监测，以降低不良心血管事件发生率。
目的：探究急性心肌梗死患者利用左心室射血分數（LVEF）及 QRS 波對心髒性猝死（SCD）事件的預測效能，併為這類疾病早期榦預提供支撐。方法迴顧性分析于2010年7月至2013年4月收治的106例急性心肌梗死患者資料，對其追蹤隨訪10箇月，根據患者是否存活進行分組，分彆設為存活組和 SCD 組。利用超聲心動圖測定 LVEF、體錶心電圖測定 QRS 波長及 QTc 間期數據。結果存活者為93例（87.7%），SCD 為13例（12.3%）。SCD 組患者院外除顫率高于存活組（ P ﹤0.05），院內接受介入治療、藥物保守治療、吸煙及高血脂率高于存活組（ P ﹤0.05）。兩組患者在性彆構成比、年齡、體質指數、高血壓、糖尿病、梗死部位等方麵差異無統計學意義（ P ﹥0.05）。存活組 QRS 波寬度為（103.2±4.2）ms，小于 SCD 組（116.3±5.8）ms，差異有統計學意義（ P ﹤0.05）；存活組 LVEF 值為（52.9±3.1）%，高于 SCD 組（34.8±2.7）ms，差異有統計學意義（ P ﹤0.05）；兩組 QTc 間期差異無統計學意義（ P ﹥0.05）。LVEF 預測急性心肌梗死後 SCD 的敏感度為39.2%，特異度為92.7%，真暘性率71.3%；QRS 波預測的敏感度為65.4%，特異度為66.7%，真暘性率63.2%；LVEF 聯閤 QRS 診斷的敏感度89.3%，特異度91.5%，真暘性率87.5%。LVEF 降低（25.9%vs.3.2%，P ﹤0.05）和 QRS 波增寬（9.5% vs.2.4%，P ﹤0.05）的患者遠期 SCD 髮生率較高。院外除顫[RR ＝5.9，95% CI（1.6~23.4），P ﹤0.05]、LVEF 降低[RR ＝7.1，95% CI（1.9~24.3），P ﹤0.05]及 QRS 波增寬[RR ＝3.5，95%CI（1.1~12.6），P ﹤0.05]均可作為 SCD 危險因素，具有一定的預測價值。結論 QRS 波及 LVEF 聯閤檢測能提高急性心肌梗死後 SCD 的診斷效能，患者及醫生應重視上述兩項指標的鑑測，以降低不良心血管事件髮生率。
목적：탐구급성심기경사환자이용좌심실사혈분수（LVEF）급 QRS 파대심장성졸사（SCD）사건적예측효능，병위저류질병조기간예제공지탱。방법회고성분석우2010년7월지2013년4월수치적106례급성심기경사환자자료，대기추종수방10개월，근거환자시부존활진행분조，분별설위존활조화 SCD 조。이용초성심동도측정 LVEF、체표심전도측정 QRS 파장급 QTc 간기수거。결과존활자위93례（87.7%），SCD 위13례（12.3%）。SCD 조환자원외제전솔고우존활조（ P ﹤0.05），원내접수개입치료、약물보수치료、흡연급고혈지솔고우존활조（ P ﹤0.05）。량조환자재성별구성비、년령、체질지수、고혈압、당뇨병、경사부위등방면차이무통계학의의（ P ﹥0.05）。존활조 QRS 파관도위（103.2±4.2）ms，소우 SCD 조（116.3±5.8）ms，차이유통계학의의（ P ﹤0.05）；존활조 LVEF 치위（52.9±3.1）%，고우 SCD 조（34.8±2.7）ms，차이유통계학의의（ P ﹤0.05）；량조 QTc 간기차이무통계학의의（ P ﹥0.05）。LVEF 예측급성심기경사후 SCD 적민감도위39.2%，특이도위92.7%，진양성솔71.3%；QRS 파예측적민감도위65.4%，특이도위66.7%，진양성솔63.2%；LVEF 연합 QRS 진단적민감도89.3%，특이도91.5%，진양성솔87.5%。LVEF 강저（25.9%vs.3.2%，P ﹤0.05）화 QRS 파증관（9.5% vs.2.4%，P ﹤0.05）적환자원기 SCD 발생솔교고。원외제전[RR ＝5.9，95% CI（1.6~23.4），P ﹤0.05]、LVEF 강저[RR ＝7.1，95% CI（1.9~24.3），P ﹤0.05]급 QRS 파증관[RR ＝3.5，95%CI（1.1~12.6），P ﹤0.05]균가작위 SCD 위험인소，구유일정적예측개치。결론 QRS 파급 LVEF 연합검측능제고급성심기경사후 SCD 적진단효능，환자급의생응중시상술량항지표적감측，이강저불양심혈관사건발생솔。
Objectine To explore the left ventricular ejection fraction(LVEF)and QRS wave of sudden cardiac death(Sudden cardiac death,SCD)prediction performance events in patients with acute myocardial infarction,and provide support for this kind of disease,early inter-vention. Methods A retrospective review of 106 patients with acute myocardial infarction were performed. The follow - up time was about 10 months. According to whether the patients survival group,the patients were divided into survival group and SCD group. Beckoning diagram deter-mination of LVEF,QRS and QTc of electrocardiogram measuring wavelength interval data were detected by using ultrasound. Results 93 cases (87. 7% )were considered as the survivors,SCD included 13 cases(12. 3% ). The defibrillation rate in patients of SCD group outside hospital was higher than the survival group( P ﹤ 0. 05). Undergoing interventional therapy and drug conservative treatment was higher than that in the sur-vival group hospital( P ﹤ 0. 05). No statistically significant differences between two groups were found in gender,age,BMI,hypertension,dia-betes,cerebral infarction( P ﹥ 0. 05). The survival group QRS wave width was(103. 2 ± 4. 2)ms,less than the SCD group(116. 3 ± 5. 8)ms, the difference was statistically significant( P ﹤ 0. 05). The LVEF value of the survival group was(52. 9 ± 3. 1)% ,which was higher than that in SCD group(34. 8 ± 2. 7)ms,the difference was statistically significant( P ﹤ 0. 05). The two group QTc interval did not show significant differ-ences( P ﹥ 0. 05). LVEF prediction after acute myocardial infarction in SCD with a sensitivity of 39. 2% ,specificity of 92. 7% ,true positive rate of 71. 3% . In QRS wave prediction,sensitivity was 65. 4% ,specificity was 66. 7% ,the true positive rate 63. 2% ;the sensitivity of 89. 3% . In LVEF combined with QRS in diagnosis,the specificity was 91. 5% ,the true positive rate of 87. 5% . LVEF decreased(25. 9% vs. 3. 2% ,P﹤ 0. 05)and QRS was wide(9. 5% vs. 2. 4% ,P ﹤ 0. 05)of the patients,who had a higher incidence of SCD. Pre - hospital defibrillation[RR= 5. 9,95% CI(1. 6 ~ 23. 4),P ﹤ 0. 05],LVEF decreased[RR = 7. 1,95% CI(1. 9 ~ 24. 3),P ﹤ 0. 05]and QRS wave width[RR = 3. 5, 95% CI(1. 1 ~ 12. 6),P ﹤ 0. 05]can be used as the risk factors of SCD,has some predictive value. Conclusion QRS and LVEF joint detec-tion can improve the diagnostic efficacy of sudden cardiac death after acute myocardial infarction,patients and doctors should pay attention to moni-toring the above 2 indicators,in order to reduce the incidence of adverse cardiovascular events.
