心电图碎裂QRS波与冠心病冠脉病变的相关性研究

发布时间：2018-04-27 00:19

本文选题：冠心病 + 冠脉造影　；参考：《昆明医科大学》2016年硕士论文

【摘要】：[目的]冠状动脉粥样硬化性心脏病(Coronary atherosclerotic heart disease, CHD)简称冠心病,是由于脂质代谢异常,血液中的脂质沉着在原本光滑的冠状动脉内膜上形成粥样斑块,粥样斑块沉积造成冠状动脉管腔狭窄或闭塞,导致心肌缺血缺氧或坏死而引起的心脏代谢及功能异常。随着我国物质生活水平提高、工作压力增大、生活方式不合理、人口老龄化等社会问题日益凸显,冠心病的发病率呈明显上升趋势及年轻化趋势,是目前严重威胁我国中老年健康的心血管疾病之一,其预后及并发症的发生主要与冠状动脉病变部位、程度及病变范围相关,早期发现病变并评估病情,进行及时有效的治疗对改善患者预后、控制疾病发展、延长生存时间、提高生活质量等起到至关重要的作用。目前,经皮冠状动脉造影因其准确性、直观性等,是诊断冠心病的金标准。但属于有创性的检查,费用较高,对操作者有着专业技术要求,且具有一定的风险性,故其在人群中的普及尚有阻力。标准体表十二导联心电图(ECG)发展历史悠久,鉴于其快速、有效、便捷、价廉、无创及可重复性等优点,在冠心病的诊断中占有不可或缺的重要地位。当心肌缺血、坏死或瘢痕组织形成时,心室肌细胞发生除极与传导延迟和缓慢,在心电图上形成形态不规整的QRS波,即碎裂QRS波(Fragmentation QRS complex, fQRS)。本研究的目的在于通过分析冠心病患者fQRS的出现与冠状动脉病变情况的关系,了解fQRS在冠心病的诊断及病情评估方面的应用价值,指导冠心病的临床诊治。[方法]本研究收集了2015年01月至2015年12月入住玉溪市人民医院心内科治疗的患者486例,所有患者均行冠状动脉造影检查,并完善心脏彩色多普勒超声、静息心电图及相关血生化检查,且排除了存在束支及室内传导阻滞、心电图预激图形、起搏器植入、电解质紊乱、心室肥厚、先天性心脏结构异常、心肌病等影响研究结果的病例。根据检查结果按冠状动脉病变程度分为冠心病组(狭窄≥50%)和非冠心病组(狭窄50%),根据是否出现fQRS波,分为fQRS组和无fQRS组。根据Gensini评分分为40分、40-80分、80分三组。根据三支主支冠脉血管及其分支狭窄最重部位的狭窄程度分为50%、50-74%、75-99%、完全闭塞组。根据病变血管分为前降支病变、回旋支病变、右冠病变。综合所有数据进行碎裂QRS波的出现情况与冠状动脉病变范围、狭窄程度、病变血管的相关性分析。[结果]本研究共有486例患者,其中明确诊断为冠心病者(冠脉病变程度≥50%)394例,非冠心病者(冠脉病变程度50%)92例。按是否出现fQRS分为fQRS组240例(冠心病220例)和无fQRS组246例(冠心病174例)。1冠状动脉病变范围冠心病患者fQRS组与无fQRS组,两组的各Gensini评分(40分组、40-80分组、80分组)病例所占比例分别为74人(33.6%)Vs 93人(53.4%)、88人(40.0%)Vs 51人(29.3%)、58人(26.4%)Vs 30人(17.2%),各比较组间均P0.05,差异有统计学意义。非冠心病组(狭窄50%),冠心病患者按Gensini评分分为40分组、40-80分组、80分组,比较4组间fQRS的检出率分别为20人(21.7%)、74人(44.3%)、88人(63.3%)、58人(65.9%),除40-80分组与80分组间比较P0.05,差异无统计学意义外,余相邻两组间P0.05,差异有统计学意义。冠心病患者fQRS组按照Gensini评分40分组与40-80分组fQRS出现导联数比较Z=-3.204,P=0.001；40-80分组与80分组fQRS出现导联数比较Z=-3.676,P=0.000。2冠状动脉狭窄程度fQRS组与无fQRS组的各狭窄程度(50%、50-74%、75-99%、完全闭塞)病例所占比例分别为20人(8.3%)Vs 72人(29.3%)、34人(14.2%)Vs 47人(19.1%)、107人(44.6%)Vs 96人(39.0%)、79人(32.9%)Vs 31人(12.6%),其中50%组、完全闭塞组P0.05,差异有统计学意义,余2组P≥0.05,差异无统计学意义。按狭窄程度分为50%组、50-74%组、75-99%组、完全闭塞组,比较4组间fQRS的检出率分别为20人(21.7%)、34人(42.0%)、107人(52.7%)、 79人(71.8%),除50-74%组与75-99%组间比较P0.05,差异无统计学意义外,余相邻两组间P0.05,差异有统计学意义。冠心病患者fQRS组狭窄程度50-74%与75-99%相比较,fQRS出现导联数Z=-2.414,P=0.000；75-99%与完全闭塞组相比较,fQRS出现导联数比较Z=--3.970,P=0.000。3病变血管冠心病患者fQRS组与无fQRS组前降支、回旋支、右冠病变所占比例分别为197例(89.5%)Vs 158例(90.8%)、137例(62.3%)Vs 105例(60.3%)、166例(75.5%)Vs 118例(67.8%),各比较组间均P0.05,差异无统计学意义。[结论]1.心电图fQRS的出现对冠心病患者冠状动脉病变范围及狭窄程度具有一定的预测价值,可协助临床快速对冠心病患者进行病情初步评估并选择最合适的治疗。2.冠心病患者fQRS出现的导联数对冠脉病变程度及范围亦有一定的预测价值。3.fQRS波对冠脉病变有一定的诊断价值,但尚不能因其出现的相应导联而明确相关病变血管。4.fQRS在成年男性的检出率较女性为高。
[Abstract]:[Objective] coronary atherosclerotic heart disease (Coronary atherosclerotic heart disease, CHD) is referred to as coronary heart disease (CAD) for short. It is caused by abnormal lipid metabolism. The lipid deposits in the blood form atheromatous plaque on the original smooth coronary intima. Atherosclerotic plaque deposits cause the stenosis or occlusion of the coronary artery cavity, leading to myocardial ischemia and hypoxia. With the improvement of the level of material life, the increase of the working pressure, the irrational way of life, the aging of the population and other social problems, the incidence of coronary heart disease is on the rise and the trend of youth. It is one of the cardiovascular diseases that threaten the health of the middle-aged and the elderly in our country at present. The prognosis and complications are mainly related to the location, degree and extent of the coronary artery disease. Early detection and evaluation of the disease and timely and effective treatment will play an important role in improving the prognosis of the patients, controlling the development of the disease, prolonging the survival time, and improving the quality of life. Accuracy, intuition, and so on, is the gold standard for diagnosis of coronary heart disease. But it is a invasive examination, the cost is high, the operator has a professional technical requirement, and it has a certain risk, so it has a resistance in the popularity of the population. The standard body surface twelve lead electrocardiogram (ECG) has a long history, in view of its rapid, effective, convenient, cheap, and low price In the diagnosis of coronary heart disease, it plays an indispensable role in the diagnosis of coronary heart disease. When myocardial ischemia, necrosis or scar tissue is formed, the depolarization and conduction of the ventricular myocytes are delayed and slow, and the form of irregular QRS wave (Fragmentation QRS complex, fQRS) is formed on the electrocardiogram. The purpose of this study is the purpose of this study. In the analysis of the relationship between the appearance of fQRS and the coronary artery disease in patients with coronary heart disease, we know the value of fQRS in the diagnosis and evaluation of coronary heart disease and guide the clinical diagnosis and treatment of coronary heart disease. [Methods] this study collected 486 cases of patients who were treated in Department of Cardiology of Yuxi People's Hospital from 01 months to December 2015 from 01 months to December 2015. Coronary angiography was performed in all patients, and color Doppler echocardiography, resting electrocardiogram and related blood biochemical examination were perfected, and the results of the study were excluded from the results of the study, including the existence of bundle branch and indoor conduction block, electrocardiogram preexcitation pattern, pacemaker implantation, electrolyte disturbance, ventricular hypertrophy, congenital heart structure abnormalities, cardiomyopathy and so on. According to the degree of coronary artery disease, according to the degree of coronary artery disease, it was divided into coronary artery disease group (stenosis more than 50%) and non coronary heart disease group (50%). According to whether fQRS wave was found, fQRS group and non fQRS group were divided into 40 points, 40-80 points and 80 points three groups according to the score of the coronary artery. The stenosis degree of the coronary artery and its branches in three main branches was divided into 50%, 50-74 A total of 486 cases of coronary artery disease (coronary lesions) were clearly diagnosed as coronary lesions. [results] 486 patients were diagnosed as coronary artery disease (coronary lesions). Degree above 50%) 394 cases, non coronary heart disease (50%) 92 cases, according to whether fQRS divided into group fQRS 240 cases (220 cases of coronary heart disease) and no fQRS group 246 cases (coronary heart disease 174),.1 coronary artery disease patients with coronary artery disease fQRS group and no fQRS group, two group Gensini score (40, 40-80 groups, 80 group) accounted for the proportion of cases respectively For 74 people (33.6%) Vs 93 (53.4%), 88 (40%) Vs 51 (29.3%), 58 (26.4%) Vs 30 (17.2%), the difference was statistically significant between the different groups. The non coronary heart disease group (stenosis 50%), the coronary heart disease patients were divided into 33.6% groups according to the Gensini score. (63.3%), 58 people (65.9%), except between the 40-80 and 80 groups, the difference was not statistically significant, the difference was statistically significant between the two groups of adjacent two groups. The number of lead in the group fQRS of the patients with coronary heart disease was Z=-3.204, P=0.001, and the 40-80 group was compared with the 80 packet fQRS in the group fQRS of coronary heart disease, and the number of the lead of the 40-80 group was compared with the 80 group fQRS. 6, P=0.000.2 coronary artery stenosis degree fQRS group and no fQRS group (50%, 50-74%, 75-99%, complete occlusion) accounted for 20 (8.3%) Vs 72 (29.3%), 34 (14.2%) Vs 47 (19.1%), 107 (44.6%) Vs 96 (44.6%) Vs 96 people (19.1%), Vs group, P0.05, total occlusion group P0.05, the difference was statistically significant. According to the degree of stenosis, the difference was not statistically significant. According to the degree of stenosis, there were 50% groups, group 50-74%, group 75-99%, and complete occlusion group, and the detection rates of fQRS were 20 (21.7%), 34 (42%), 107 (52.7%), 79 (71.8%), except 50-74% group and 75-99% group, and the difference was not statistically significant, the difference between the remaining P0.05 groups between adjacent two groups was different. The difference between the 2 groups was not statistically significant. There was statistical significance. The stenosis degree of fQRS group in coronary heart disease patients was compared with 75-99%, and the number of fQRS leads to Z=-2.414, P=0.000; 75-99% was compared with the complete occlusion group, and the number of fQRS appeared in Z=--3.970, and the proportion of the fQRS group and the anterior descending branch in the fQRS group and the non fQRS group, the circumflex branch and the right crown lesion were 197, respectively. Cases (89.5%) Vs 158 cases (90.8%), 137 cases (62.3%) Vs 105 cases (60.3%), 166 cases (75.5%) Vs 118 cases (67.8%), all the comparison groups were all P0.05, the difference was not statistically significant. [conclusion]1. electrocardiogram fQRS has a certain predictive value for coronary artery disease range and stenosis in patients with coronary heart disease, which can help clinical patients with coronary heart disease quickly. Preliminary evaluation and selection of the most suitable treatment for.2. patients with coronary heart disease, the number of fQRS leads to the degree and scope of coronary artery disease also has a certain predictive value,.3.fQRS wave has certain diagnostic value for coronary lesion, but it is not clear that the detection rate of the related vascular.4.fQRS in adult male is not clear because of its corresponding lead. The sex is high.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.4;R540.41

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