碎裂QRS波辅助诊断心肌梗死的临床价值

摘要

目的:探讨心电图碎裂QRS波对于诊断急性心肌梗死(AMI)的临床价值.方法:对2013年4月至2014年4月间来本院就诊的AMI患者102例(AMI组)和冠心病(CHD)患者132例(CHD组)的临床资料进行回顾性研究,并将同期来本院体检的健康者120例作为正常对照组.通过心肌灌注断层显像扫描确诊AMI,所有研究对象均接受ECG检查,记录不同部位的碎裂QRS波和病理性Q波的发生率.比较碎裂QRS波与病理性Q波诊断AMI的敏感性、特异性和准确性.结果:碎裂QRS波在AMI组患者的下壁发生率最高,病理性Q波在AMI组患者的前壁发生率最高.除侧壁的碎裂QRS波以外,与正常对照组比较,AMI组和CHD组的前壁(0.8%比22.5%、13.6%)、下壁碎裂QRS波(6.7%比26.5%、17.4%);前壁(0比41.2%、29.5%)、下壁(0.8%比40.2%、35.6%)和侧壁病理性Q波(0比2%、2.3%)的发生率均显著升高 (P均<0.01).与病理性Q波比较,碎裂QRS波诊断AMI的敏感性(40.00%比89.47%): 诊断CHD的敏感性(41.94%比91.50%)显著升高(P均<0.01),但在特异性和准确性方面二者无显著差异(P均>0.05).结论:碎裂 QRS 波可作为诊断急性心肌梗死的重要辅助指标,与病理性Q波联合诊断可进一步提高心电图在急性心肌梗死诊断中的应用价值.%Objective: To explore auxiliary diagnostic value of fragmented QRS complex on ECG for acute myocardial infarction (AMI).Methods: Clinical data of 102 AMI patients (AMI group) and 132 CHD patients (CHD) group, who were treated in our hospital from Apr 2013 to Apr 2014, were retrospectively studied, another 120 healthy subjects undergoing physical examination in our hospital during the same period were regarded as normal control group.AMI was diagnosed by myocardial perfusion tomography, all subjects received ECG examination, and incidence rates of fragmented QRS complex and pathological Q wave at different sites were recorded.Sensitivity, specificity and accuracy of fragmented QRS complex and pathological Q wave diagnosing AMI were compared.Results: Incidence rate of fragmented QRS complex was highest on inferior wall in AMI group, and that of pathological Q wave was highest on anterior wall in AMI group.Except fragmented QRS complex in sidewall, compared with normal control group, there were significant rise in incidence rates of fragmented QRS complex on anterior wall (0.8% vs.22.5%, 13.6%) and inferior wall (6.7% vs.26.5%, 17.4%);pathological Q wave on anterior wall (0 vs.41.2%, 29.5%), inferior wall (0.8% vs.40.2%, 35.6%) and side wall (0 vs.2%, 2.3%) in AMI group and CHD group, P<0.01 all.Compared with pathological Q wave, there was significant rise in diagnosing sensitivity for AMI (40.00% vs.89.47%), for CHD (41.94% vs.91.50%) of fragmented QRS complex (P<0.01 both), but there were no significant difference in specificity and accuracy between them (P>0.05 all).Conclusion: Fragmented QRS complex can be used as an important auxiliary index diagnosing acute myocardial infarction.When combined with pathological Q wave, it can further improve diagnostic value of ECG for acute myocardial infarction.