急性冠脉综合征伴缺血性J波的临床探讨

发布时间：2018-09-05 07:36

【摘要】：目的:通过检测急性冠脉综合征患者心电图中出现缺血性J波的临床特点,探讨缺血性J波对急性冠脉综合征患者发生恶性心血管事件的诊断价值及临床意义。方法:选取2015年1月-2016年8月我院及兰州大学第一医院急性冠脉综合征患者149例,对这些患者入院后行心电图及动态心电图检查,根据心电图及动态心电图中有无缺血性J波分缺血性J波组及非缺血性J波组。探讨:1.缺血性J波与非缺血性J波组患者的一般情况比较,如年龄、性别、24小时平均心率等;2.缺血性J波在急性冠脉综合征的三种类型中哪一种的发生率最高;3.急性冠脉综合征患者心电图中缺血性J波的常见发生部位比较;4.缺血性J波的出现是否易发生室性心律失常;5.缺血性J波合并室性心律失常的发生与心脏冠脉血管的相关性。结果:149例患者中缺血性J波有63例,平均心率为(75.5±16.7)次/分,非缺血性J波86例,平均心率(66.0±12.1)次/分;急性冠脉综合征(acme coronary syndrome,ACS)三种类型中(STEMI、NSTEMI、UA)缺血性J波的检出率各占52.9%、27.6%、28.6%,P0.05;缺血性J波在下壁中的发生率为61.8%,在前壁中的发生率为29.5%,P0.05;缺血性J波合并室性心律失常的发生率为41.3%远大于非缺血性J波合并室性心律失常的发生率19.8%,P=0.04;缺血性J波合并室性心律失常的发生与左冠状动脉病变所占比率高达69.2%。结论:本研究中缺血性J波更易发生在急性ST段抬高型心肌梗死中;缺血性J波组的平均心率较非缺血性J波组快;ACS中ST段抬高型心肌梗死更易在心电图中发现缺血性J波且以下壁为著[1];因搜集的病例数有限,左冠状动脉、回旋支,右冠状动脉分开研究例数较少,即合并为左、右冠状动脉。ACS合并缺血性J波的患者发生室性心律失常的可能性增加且发生在左冠状动脉中的比重较高,说明缺血性J波的出现与患者心电学不稳定密切相关,因缺血性J波发生的离子机制是心肌缺血时钾离子向心外膜移动增加,导致心室内外膜形成电位差,进而可增加心脏恶性事件发生的可能性。
[Abstract]:Objective: to investigate the diagnostic value and clinical significance of ischemic J wave in patients with acute coronary syndrome (ACS) by detecting the clinical features of ischemic J wave in electrocardiogram (ECG). Methods: 149 patients with acute coronary syndrome (ACS) in our hospital and the first Hospital of Lanzhou University from January 2015 to August 2016 were examined by electrocardiogram (ECG) and dynamic electrocardiogram (ECG). There were ischemic J wave groups and non ischemic J wave groups according to electrocardiogram (ECG) and dynamic electrocardiogram (ECG). Probe into 1: 1. The general condition of ischemic J wave group was compared with that of non ischemic J wave group, such as age, sex, 24 hours mean heart rate, etc. Which of the three types of acute coronary syndrome has the highest incidence of ischemic J wave? The common location of ischemic J wave in electrocardiogram of patients with acute coronary syndrome was 4. 4%. Whether the occurrence of ischemic J wave is prone to ventricular arrhythmia 5. Relationship between ischemic J wave and ventricular arrhythmias. Results among 149 cases, 63 cases had ischemic J wave, the average heart rate was (75.5 卤16.7) beats / min, non-ischemic J wave was 86 cases, mean heart rate was (66.0 卤12.1) beats / min; In the three types of acute coronary syndrome (acme coronary syndrome,ACS), the detectable rate of ischemic J wave (STEMI,NSTEMI,UA) was 52.9% and 27.6%, respectively (P 0.05); the incidence of ischemic J wave in the inferior wall was 61.8%, and that in the anterior wall was 29.5g / kg (P 0.05); the incidence of ischemic J wave with ventricular arrhythmia was 29.5%; the incidence of ischemic J wave associated with ventricular arrhythmias was 52.9%; the incidence of ischemic J wave in the inferior wall was 29.5% (P 0.05). The incidence of ventricular arrhythmia was significantly higher in 41.3% than that in non-ischemic J wave with ventricular arrhythmia, and the incidence of ischemic J wave with ventricular arrhythmia was as high as 69.2%. Conclusion: in this study, ischemic J wave is more likely to occur in acute ST segment elevation myocardial infarction. The average heart rate of ischemic J wave group was faster than that of non ischemic J wave group in ST segment elevation myocardial infarction. There were fewer cases of right coronary artery separation, that is, patients with left, right coronary artery. ACS combined with ischemic J wave were more likely to develop ventricular arrhythmia and had a higher proportion in left coronary artery. It is suggested that the occurrence of ischemic J wave is closely related to the unstable electrocardiogram. The ion mechanism of ischemic J wave is the increase of potassium ion moving to the epicardium during myocardial ischemia, which leads to the formation of potential difference between the inner and outer membranes of the ventricle. In turn, it can increase the likelihood of malignant cardiac events.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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