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目的探讨经皮冠状动脉介入术(PCI)对急性心肌梗死(AMI)患者碎裂QRS波(fQRS)的影响及预后情况。方法选择2010年7月—2011年6月我院收治并确诊的AMI患者137例,其中男109例,女28例;平均年龄(60.5±12.5)岁。按病情不同将患者分为急诊PCI组31例、择期PCI组61例、未行PCI(拒绝或无法行PCI治疗)组45例,于术前、术后当天、术后1周、术后2周及随访6个月时分别行常规心电图检查,观察fQRS的发生率;同时根据体表心电图有无fQRS将其分成两组〔fQRS组(70例)和无fQRS组(67例)〕,比较两组室性心律失常的发生率。结果急诊PCI组、择期PCI组、未行PCI组患者的年龄、性别及高血压、糖尿病、陈旧性心肌梗死、脑梗死、心房纤颤的患病率比较,差异无统计学意义(P>0.05)。3组患者左心室射血分数(LVEF)和室壁节段性运动异常率比较,差异无统计学意义(P>0.05)。137例患者中急诊PCI组、择期PCI组及未行PCI组患者术前心电图梗死部位对应导联可见fQRS者分别为14例(45.2%)、35例(57.4%)、21例(46.7%);术前、术后当天、术后1周3组心电图fQRS发生率比较,差异无统计学意义(P>0.05);而在术后2周和随访6个月时3组fQRS发生率比较,差异有统计学意义(P<0.05);且术后2周急诊PCI组与择期PCI组患者心电图fQRS发生率较未行PCI组均降低(P<0.01),随访6个月时急诊PCI组心电图fQRS发生率较择期PCI组和未行PCI组降低(P<0.01)。3组患者住院期间室性心律失常发生率比较,差异有统计学意义(P<0.05);而住院期间病死率比较,差异无统计学意义(P>0.05)。心电图有fQRS组室性心律失常发生率高于无fQRS组〔8.6%(6/70)与0%(0/67),P=0.028〕。结论 AMI后fQRS可能与室性心律失常的发生有关,早期开通冠状动脉血管可以降低心电图fQRS及室性心律失常的发生率,为临床治疗提供有益参考。
Objective To investigate the effect and prognosis of fragmented QRS wave (FQRS) in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Methods A total of 137 AMI patients admitted to our hospital from July 2010 to June 2011 were diagnosed as 109 cases of males and 28 females with an average age of 60.5 ± 12.5 years. The patients were divided into emergency PCI group (31 cases), elective PCI group (61 cases) and no PCI group (45 cases refused or no PCI treatment group). The patients in preoperative and postoperative day, postoperative 1 week and postoperative 2 The patients were divided into two groups (fQRS group (70 cases) and no fQRS group (67 cases) according to the presence or absence of fQRS on the body surface electrocardiogram (ECG). The incidence of ventricular arrhythmias in both groups. Results There was no significant difference in the prevalence of age, gender, hypertension, diabetes mellitus, old myocardial infarction, cerebral infarction and atrial fibrillation in emergency PCI group, elective PCI group and non-PCI group (P> 0.05 ). There was no significant difference in left ventricular ejection fraction (LVEF) and segmental motion abnormality between the three groups (P> 0.05). 137 cases of patients with emergency PCI, elective PCI group and no PCI group, fQRS were 14 cases (45.2%), 35 cases (57.4%), 21 cases (46.7% ; There was no significant difference in the incidence of electrocardiogram (FQRS) between preoperative group, postoperative day, and postoperative 1 week group 3 (P> 0.05), while the incidence of fQRS in 3 groups at 2 weeks postoperatively and at 6 months’ (P <0.05). The incidence of electrocardiographic fQRS in emergency PCI group and elective PCI group was lower than that in non-PCI group at 2 weeks after PCI (P <0.01). At 6 months follow-up, the electrocardiogram The incidence of fQRS was lower than that of elective PCI group and non-PCI group (P <0.01). There were significant differences in the incidence of ventricular arrhythmia between the three groups during hospitalization (P <0.05), while there was no significant difference in mortality during hospitalization (P> 0.05). The incidence of ventricular arrhythmias in the fQRS group was higher in the electrocardiogram group than in the fQRS group (8.6% (6/70) vs 0% (0/67), P = 0.028). Conclusion The fQRS after AMI may be related to the occurrence of ventricular arrhythmia. The early opening of coronary artery can reduce the incidence of electrocardiogram (FQRS) and ventricular arrhythmia and provide a useful reference for clinical treatment.