超声心动图联合心电图QRS碎裂波诊断心肌梗死的临床价值

目的探讨超声心动图检测左室功能指标联合心电图QRS碎裂波(fQRS)与冠状动脉病变及室性心律失常等临床特点的关系。方法将117例心肌梗死患者根据十二导联心电图QRS波形态分为fQRS波组(75例)及无fQRS波组(42例),其中fQRS波组又根据左室射血分数(LVEF)情况分为LVEF下降组(A组)和左室射血分数正常组(B组),无fQRS波组简称为C组。分析各组冠状动脉造影结果,采用动态心电图分析室性心律失常,并进行组间对比。结果冠状动脉造影:A组冠状动脉单支病变3例(6.7%),多支病变42例(93.3%);B组冠状动脉单支病变8例(26.7%),多支病变22例(73.3%);C组冠状动脉单支病变29例(69.04%),多支病变13例(30.96%),其中B、C组多支病变百分比较A组小,差异有统计学意义(P0.05)。A组完全性闭塞发生率(51.1%)显著高于B组(13.3%),C组(7.14%),差异均有统计学意义(均P0.05)。室性心律失常分析:室性期前收缩Lown分级Ⅲ级、ⅣA级、ⅣB级比较,其中A组ⅣB级发生率(35.6%)高于B组(3.33%)、C组(0);C组ⅣA级发生率(19%)明显低于A组(48.9%)、B组(33.3%),差异有统计学意义(均P0.05)。超声心动图检测:左室舒张末期内径A组(51.11±8.44)mm与B组(50.99±7.34)mm、C组(48.76±6.53)mm比较差异均无统计学意义。结论心肌梗死患者LVEF下降合并fQRS波者冠状动脉多支病变,冠状动脉完全性闭塞及严重室性心律失常发生率明显高于LVEF正常合并fQRS波及无fQRS波者,两项指标联合应用对高危心肌梗死预警有一定临床意义。

Preliminary research on clinical value in diagnosis of myocardial infarction using echocardiography and fragmented QRS complex

Objective To explore the relationship between echocardiography combined with fragmented QRS complex and clinical characteristics,such as coronary artery disease and ventricular arrhythmias. Methods According to the shape of QRS and echocardiography,117 patients with myocardial infarction（MI）were divided into fQRS with low LVEF group（A group,n=45）,fQRS with normal LVEF group（B group,n=30）and no fQRS group（C group,n=42）. Coronary angiography results were analyzed. Ventricular arrhythmias was analyzed by dynamic electrocardiogram. The comparison among groups was proceeded.Results Coronary angiography： There were 3 cases of single-vessle coronary lesions（6.7%）and 42 cases of multivessle coronary lesions（93.3%）in A group. There were 8 cases of single-vessle coronary lesions（26.7%）and 22 cases of multivessle coronary lesions（73.3%）in B group. There were 29 cases of single-vessle coronary lesions（69.04%）and 13 cases of multivessle coronary lesions（30.96%）in C group. The percentage of multivessle coronary lesions in B and C group was smaller than that in A group（P0.05）. The incidence of complete occlusion in A group was higher than that in B and C group（P0.05）. Analysis of ventricular arrhythmias： The incidence of Lown ⅣB grade in A group（35.6%）was higher than that in B group（3.33%）and C group（0）（P0.05）. The incidence of Lown ⅣA grade in C group（19%）was lower than that in A group（48.9%）and B group（33.3%）（P0.05）. Echocardiography detection： The LVDD in A group（51.11±8.44）mm]was higher than that in B group（50.99±7.34）mm]and C group （48.76±6.53）mm]. There was no significant difference among the groups. Conclusion The MI patients with low LVEF and fQRS have higher incidence in multivessel coronary lesions,complete occlusion and severe ventricular arrhythmia than those with fQRS with normal LVEF and no fQRS. The combination of two indicators has a certain clinical significance for predicting high risk of myocardial infa