经皮冠状动脉介入术对急性心肌梗死碎裂QRS波的影响及预后分析

摘要

目的：探讨经皮冠状动脉介入术（ PCI）对急性心肌梗死（ AMI）患者碎裂QRS波（ fQRS）的影响及预后情况。方法选择2010年7月-2011年6月我院收治并确诊的AMI患者137例，其中男109例，女28例；平均年龄（60.5±12.5）岁。按病情不同将患者分为急诊PCI组31例、择期PCI组61例、未行PCI（拒绝或无法行PCI治疗）组45例，于术前、术后当天、术后1周、术后2周及随访6个月时分别行常规心电图检查，观察fQRS的发生率；同时根据体表心电图有无fQRS将其分成两组〔fQRS组（70例）和无fQRS组（67例）〕，比较两组室性心律失常的发生率。结果急诊PCI组、择期PCI组、未行PCI组患者的年龄、性别及高血压、糖尿病、陈旧性心肌梗死、脑梗死、心房纤颤的患病率比较，差异无统计学意义（P＞0.05）。3组患者左心室射血分数（LVEF）和室壁节段性运动异常率比较，差异无统计学意义（ P＞0.05）。137例患者中急诊PCI组、择期PCI组及未行PCI组患者术前心电图梗死部位对应导联可见fQRS者分别为14例（45.2％）、35例（57.4％）、21例（46.7％）；术前、术后当天、术后1周3组心电图fQRS发生率比较，差异无统计学意义（ P＞0.05）；而在术后2周和随访6个月时3组fQRS发生率比较，差异有统计学意义（P＜0.05）；且术后2周急诊PCI 组与择期 PCI 组患者心电图 fQRS 发生率较未行 PCI 组均降低（P ＜0.01），随访6个月时急诊PCI组心电图fQRS发生率较择期PCI组和未行PCI组降低（P＜0.01）。3组患者住院期间室性心律失常发生率比较，差异有统计学意义（ P＜0.05）；而住院期间病死率比较，差异无统计学意义（ P＞0.05）。心电图有fQRS组室性心律失常发生率高于无 fQRS组〔8.6％（6/70）与0％（0/67），P＝0.028〕。结论 AMI 后fQRS可能与室性心律失常的发生有关，早期开通冠状动脉血管可以降低心电图fQRS及室性心律失常的发生率，为临床治疗提供有益参考。%Objective To research the effects of percutaneous coronary intervention ( PCI ) on fragmented QRS (fQRS)complex in acute myocardial infarction(AMI)patients and their prognosis. Methods A total of 137 AMI patients〔109 males,28 females,meanly aged(60. 5 ± 12. 5) years〕admitted to this hospital from July 2010 to June 2011 were divid-ed into groups A(given emergency PCI,n=31),B(given PCI in a good time,n=61),C(not given PCI,n=45). Con-ventional ECG was conducted before PCI,on that day of PCI,in weeks 1,2,months 6 after PCI,and the changes of incidence of fQRS were observed. The patients were divided,according to existence of fQRS in surface ECG,into groups fQRS(n=70), non-fQRS(n=67)and the incidences of ventricular arrhythmia was compared between 2 groups. Results There was no sig-nificant difference in age,sex,incidences of hypertension,diabetes,old myocardial infarction,brain infarction,atrial fibrilla-tion in groups A,B,C(P>0. 05). There was no difference in left ventricular ejection fraction(LVEF),ventricular regional wall motion abnormality rate in groups A,B,C(P>0. 05). The fQRS complex was seen in corresponding leads of AMI sites of ECG in 14 of group A(45. 2%),35 of group B(57. 4%),21 of group C(46. 7%)before PCI,and there was no difference in fQRS incidence before PCI,on that day of PCI,in week 1 after PCI in 3 groups(P>0. 05),but there was in weeks 2, months 6 after PCI(P<0. 05). The incidence of fQRS was lower in groups A,B than in group C in weeks 2(P<0. 01), lower in group A than in groups B,C in months 6(P<0. 01). There was difference in incidence of ventricular arrhythmia in groups A,B,C during hospitalization(P<0. 05),but there was not in hospital fatality rate(P>0. 05). The incidence of ventricular arrhythmia was higher in group fQRS than in group non -fQRS〔8. 6%( 6/70 ) vs. 0%( 0/67 ), P =0. 028〕. Conclusion Post-AMI fQRS may be related to incidence of ventricular arrhythmia. Early opening of coronary vessels can re-duce the incidence of ECG fQRS and ventricular arrhythmia.