心电图碎裂QRS波与急性心肌梗死患者室性心律失常及左心室收缩功能的相关性

目的探讨急性心肌梗死(AMI)患者碎裂QRS波(fQRS)与室性心律失常、心率变异性(HRV)、左心室收缩功能的相关性。方法随机选择我院2011年1月至2012年10月确诊为AMI的住院患者120例。男性99例,女性21例,28⁸2岁,平均(60±13)岁。根据12导心电图QRS波形态分为3组:A组:fQRS组、B组:病理性Q波组、C组:fQRS合并病理性Q波组。采用动态心电图分析室性心律失常、HRV各项时域参数指标;心脏彩超检测左心室舒张末期内径(LVDD)及左心室射血分数(LVEF),并进行3组间比较分析。结果①AMI患者室性心律失常指标室性期前收缩LOWN分级Ⅲ级、ⅣA级、ⅣB级比较,A组(34.2%、36.8%、26.3%)、C组(33.3%、28.3%、16.7%)发生率均高于B组(9.1%、4.5%、0),差异有统计学意义(均为P<0.05)。②AMI患者A组、C组心率变异性的各项时域参数指标(SDNN、SDANN index、rMSSD、pNN50、三角指标)较B组均明显降低,差异均有统计学意义(均为P<0.01)③AMI患者的LVDD A组(51.71±8.44)、C组(50.32±7.35)的显著高于B组(45.14±6.44),LVEF A组(46.92±6.96)、C组(49.00±7.80)低于B组(53.23±7.95),差异均有统计学意义(均为P<0.05)。结论 AMI患者fQRS波的出现可能与①室性心律失常,尤其是恶性室性心律失常事件及HVR明显降低有关;②患者左心室收缩功能明显下降有关。

Correlation of fragmented QRS complex in electrocardiogram with ventricular arrhythmia and left ventricular systolic function in patients with acute myocardial infarction

Objective To research the correlation of fragmented QRS complex in electrocardiogram （ECG） with ventricular arrhythmia, heart rate variability （HRV） and left ventricular systolic function in patients with acute myocardial infarction （AMI）. Methods A total of 120 patients with AMI were selected randomly in the Second Affiliated Hospital of Kunming Medical University from January 2011 to October 2012. There were 99 men and 21 women, aged from 28 to 82 with average age （60 ± 13） years old. Patients were divided into three groups according to the shape of QRS complex in 12-lead ECG： group A （fQRS）, group B （pathological Q wave） and group C （fQRS with pathological Q wave）. Ventricular arrhythmia and HRV （by dynamic ECG ）, left ventricular end-diastolic diameter （LVDd） and left ventricular ejection fraction （LVEF） （ by Ultrasonic cardiogram） were analyzed and compared among three groups. Results The incidence of ventricular arrhythmia （Lown grade III, IVA and IVB） in group A （34. 2% , 36. 8% and 26.3% ）and group C （33.3%, 28.3% and 16. 7% ） were significantly higher than those in group B （9. 1% , 4. 5% and 0% ） , all P 〈0. 05. The time domain parameter indicators （ SDNN, SDANN index, rMSSD, pNNS0, triangular index） of HRV patients in group A, group C were significantly decreased than in group B, all P 〈 0. 01. LVDD of patients in group A （51.71 ± 8.44 ram） and group C （50. 32± 7.35ram） were significantly greater than in group B （45.14 ± 6.44 ram） , and LVEF of patient in group A （46. 92% ±6. 96% ）and group C （49. 00% ±7. 80% ）were significantly decreased than group B （53.23% ± 7.95% ）, all P 〈 0. 05. Conclusions fQRS may be related to the reduce of ventricular arrhythmias especially malignant ventricular arrhythmia and HRV, and related to the significant impairment of left ventricular systolic function.