碎裂QRS波对急性ST段抬高型心肌梗死患者直接介入治疗后心肌灌注及预后的预测价值

发布时间：2018-05-29 11:39

  本文选题：碎裂QRS波 + 急性ST段抬高型心肌梗死　； 参考：《广东医学》2017年12期

【摘要】：目的探讨碎裂QRS波(fQRS)对急性ST段抬高型心肌梗死(STEMI)患者直接冠状动脉介入治疗(PCI)后心肌灌注及预后的预测价值。方法回顾性选择186例STEMI行急诊PIC患者,根据介入治疗后有无新出现fQRS分为fQRS组和无fQRS组,比较术后TIMI血流(TIMI)分级、TIMI心肌灌注(TMP)分级、心电图ST段回落、肌酸激酶同工酶(CK-MB)峰值、肌钙蛋白(CTn I)峰值、术后7 d左室射血分数(LVEF)、心血管事件(MACE)和异常Q波的发生率,分析fQRS发生率与LVEF、TIMI、TMP的相关性。结果 fQRS组TIMI 3级血流获得率(51.1%)及TMP 3级灌注获得率(46.7%)显著低于无fQRS组(79.2%和77.1%)(P0.01);fQRS组90 min ST段回落≥50%(STR)(47.8%),显著低于无fQRS组(75.0%)(P0.01);fQRS组CK-MB峰值(308.4±44.8 u/d L)和CTn I峰值(66.6±2.1 ng/L)均显著高于无fQRS组(192.7±35.5 u/d L和40.8±1.8 ng/L)(P0.05);PCI术后7 d fQRS组LVEF[(35.6±5.1)%]显著低于无fQRS组[(49.7±6.4)%](P0.05);fQRS组MACE发生率(17.8%)显著高于无fQRS组(5.2%)(P0.05);fQRS组Q波发生率(75.6%)显著高于无fQRS组(44.8%)(P0.01)。fQRS发生率与LVEF呈负相关(r=-0.232,P=0.02),fQRS与TIMI血流分级和TIMI 3级呈显著负相关(r=-0.347,P=0.000;r=-0.318,P=0.002);fQRS与TMP分级和TMP3级呈显著负相关(r=-0.370,P=0.000;r=-0.325,P=0.001)。结论 STEMI术后新出现fQRS波提示心肌灌注不良,fQRS是预测STEMI患者心肌灌注和预后的有用指标。
[Abstract]:Objective to investigate the predictive value of QRS wave fQRSs in predicting myocardial perfusion and prognosis in patients with acute ST-segment elevation myocardial infarction (STEMI) after direct coronary intervention. Methods 186 patients with STEMI undergoing emergency PIC were retrospectively selected and divided into fQRS group and non-fQRS group according to whether there was any new fQRS after interventional therapy. The results were compared with that in the post-operation TIMI blood flow grade and TIMI myocardial perfusion grade, St segment receding, creatine kinase isoenzyme CK-MBs peak value. Cardiac troponin I (CTN) peak, left ventricular ejection fraction (LVEF), cardiac events (fQRS) and abnormal Q wave were observed 7 days after operation. The correlation between the incidence of fQRS and LVEFV TIMIM TMP was analyzed. Results in the fQRS group, the TIMI 3 grade blood flow rate and the TMP 3 grade perfusion rate were significantly lower than those in the no fQRS group (79.2% and 77.1% respectively), and were significantly higher than those in the 90 min St segment recessions 鈮，

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