早期复极与STEMI患者发生室性心律失常及预后的相关性研究

发布时间：2018-03-23 11:18

本文选题：早期复极　切入点：室性心律失常　出处：《安徽医科大学》2017年硕士论文

【摘要】：目的本文主要探讨早期复极(Early Repolarization ER)对急性ST段抬高型心肌梗死(acute ST-segment elevation myocardial infarction STEMI)患者住院期间发生室性心律失常(Ventricular arrhythmia VA)和远期预后的影响。方法回顾性分析298例STEMI患者临床基线资料和心电图资料,根据有无早期复极分为ER组和无ER组,其中ER组56例,无ER组242例,比较两组间住院期间基线资料、VA的发生率和随访期间全因死亡率的差异;用单因素、多因素logistics回归分析患者住院期间发生VA的危险因素。根据ER形态分为切迹型ER组和顿挫型ER组,根据ER所在导联分为下壁导联组、非下壁导联组,根据J波后ST形态分为水平型/下斜型ST段组、上斜型ST段组,分别与无ER组比较住院期间VA发生率和随访期间全因死亡率的差异。结果1、ER组和无ER组间基线资料比较差异均无统计学意义;ER组住院期间VA发生率和随访期间全因死亡率均高于无ER组,差异有统计学意义(P0.001,P=0.01);多因素Logistic回归分析ER和LVEF50%是STEMI患者住院期间发生VA的独立预测因素。2、切迹型ER组、顿挫型ER组、无ER组住院期间VA发生率及随访期间死亡率差异均有统计学差异(p0.001,P=0.02),两两比较,切迹型ER组与无ER组住院期间VA发生率及随访期间死亡率差异均有统计学差异(p0.001,p=0.004),其余各组差异无统计学意义。3、下壁导联ER组、非下壁导联ER组、无ER组住院期间VA发生率和随访期间全因死亡率差异均有统计学意义(P0.001,P=0.038),两两比较,仅下壁导联ER与无ER组住院期间VA发生率差异有统计学意义(P0.001),其余各组差异均无统计学意义。4、水平型/下斜型ST段组、上斜型ST段组、无ER组住院期间VA发生率和随访期间全因死亡率差异有统计学意义(P0.001,P=0.003),两两比较,水平型/下斜型ST段组与无ER组住院期间VA发生率和随访期间全因死亡率差异有统计学意义(P0.001,P=0.01),其余组间差异无统计学意义。结论在STEMI患者中ER特别是切迹型ER、ER伴水平型/下斜型ST段增加住院期间VA发生率和随访期间全因死亡率;下壁导联ER增加住院期间VA的发生率;ER和LVEF50%是STEMI患者住院期间发生VA的独立危险因素。
[Abstract]:Objective to investigate the effects of early Repolarization on the incidence of ventricular arrhythmias during hospitalization and long-term prognosis in patients with acute ST-segment elevation myocardial infarction STEMII (acute ST-segment elevation myocardial infarction STEMI). Methods A retrospective analysis of 298 patients with STEMI was made. Clinical baseline data and ECG data, According to whether there was early repolarization or not, ER group was divided into ER group (56 cases) and no ER group (242 cases). Multivariate logistics regression analysis was used to analyze the risk factors of VA during hospitalization. According to the morphology of ER, the patients were divided into two groups: the notch ER group and the cadaveric ER group, the lower wall lead group and the non-inferior wall lead group according to the ER lead. According to the shape of St after J wave, they were divided into horizontal / inferior St segment group and upper oblique St segment group. Results (1) there was no significant difference in baseline data between ER group and ER group. The mortality rate was higher in ER group than in ER group. Multivariate Logistic regression analysis showed that ER and LVEF 50% were independent predictors of VA in STEMI patients during hospitalization. There were significant differences in the incidence of VA during hospitalization and mortality during follow-up in ER free group. There were significant differences in the incidence of VA during hospitalization and mortality during follow-up between the ER group and the non-ER group. There was no significant difference between the other groups. The ER group with inferior wall lead and ER group with non-inferior wall lead had no significant difference in the other groups, and there was no significant difference between the two groups in the lower wall lead ER group and the non-inferior wall lead ER group. The incidence of VA during hospitalization and all-cause mortality during follow-up in ER group were significantly different (P 0.001 P 0.038). The incidence of VA in ER group was significantly different from that in non-ER group (P 0.001), but there was no significant difference in other groups (P < 0.05). The horizontal / inferior St segment group and the upper oblique St segment group had no statistical significance. The incidence of VA during hospitalization and the mortality rate during follow-up were significantly different in ER group (P 0.001 P 0.003). There were significant differences in the incidence of VA during hospitalization and total mortality during follow-up between the horizontal / inferior St segment group and the no ER group. Conclusion there was no significant difference between the other groups. Conclusion ER, especially the notch ERER associated with STEMI, is not significantly different between the other groups. Horizontal / inferior St segment increased the incidence of VA during hospitalization and all-cause mortality during follow-up. Lower wall lead ER increased the incidence of VA during hospitalization. ER and LVEF 50% were independent risk factors for VA in patients with STEMI.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22;R541.7

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