急性心肌梗死QRS波终端变形与其预后的关系

试探讨通过静息心电图形态的改变对急性心肌梗死 (AMI)患者的预后进行判定。将 397例AMI患者根据心电图QRS波终端变形分为两组即QRS(+)组 (即qR型导联的J点≥ 5 0 %的R波或Rs型导联的S波消失 )和QRS(- )组 ,通过冠状动脉造影结果及肌酸激酶和QRS计分法对梗死面积的估计将两组进行对比研究 ,并对其预后进行随访。结果 :QRS(+)组 89例 ,QRS(- )组 30 8例 ,QRS(+)组年龄偏大 ,前壁心肌梗死发生率较高。QRS(+)组血浆肌酸激酶峰值水平 (332 1± 2 5 77u/l)较QRS(- )组 (2 2 6 9± 32 5 1u/l)高 (P <0 .0 0 1) ,前壁心肌梗死患者QRS(+)组坏死面积 (7.3± 0 .34 )明显大于QRS(- )组 (5 .5± 0 .34 ,QRS计分法 ,P <0 .0 5 )且一年死亡率高于后者 (2 0 .5 %vs 9.8% ,P <0 .0 5 )。结论 :心电图QRS波终端变形可以作为早期判断心肌梗死病人预后的评价指标 ,对于前壁AMI的病人更有意义。

The Ralation Between the Distortion of the Terminal Portion of the QRS on the Electrocardiogram in Acute Myocardial Infarction and the Prognosis

To investigate prognosis of acute myocardial infarction(AMI) by electrocardiogram,397 patients of AMI were allocated into 2 groups based on the presence QRS(+)(emergence of the J point≥50% of the R wave in leads with qR configuration,or disappearance of the S wave in leads with an Rs configuration) or absence QRS(-) of QRS distortion.QRS(+) and QRS(-) groups were compared regarding the finding on the coronary angiogram and estimation of infarct size by the measurment of serum creatine kinase levels and QRS scoring system.Meanwhile,these patients were followed up so as to evaluate their prognosis.Result:The age and incidence of anterior wall AMI was higher in QRS(+) patients than in QRS(-) patients.Infarct size and one year mortality was higher ( P <0.05) for QRS(+) patients of AMI compared with QRS(-) patients,especially in anterior wall AMI.Conclusion:this simple electrocardiographic definition of presence of QRS(+) pattern may provide an early estimation of prognosis in AMI,especially in anterior wall AMI.