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目的探讨缺血性J波对急性ST段抬高心肌梗死(STEMI)发生恶性室性心律失常的预测价值。方法选择我院2005年6月至2010年7月收治的286例急性STEMI患者,以入院时体表心电图记录到缺血性J波的41例为观察组,未记录到缺血性J波的245例为对照组。比较2组患者入院48h、住院期间恶性室性心律失常发生率及2组发生恶性室性心律失常患者的QT、及QT离散度(QTd)、T波峰-末间期(Tp-Te)。结果观察组患者入院48h、住院期间恶性室性心律失常发生率明显高于对照组(P<0.05);观察组QTd、Tp-Te较对照组明显延长(P均<0.01),2组QT无明显差异(P>0.05);观察组中发生恶性室性心律失常患者的QTd、Tp-Te较同组无恶性室性心律失常患者明显延长(P均<0.01)。结论缺血性J波出现于急性STEMI患者时,恶性室性心律失常发生率增加,可作为急性STEMI患者发生恶性室性心律失常的预测指标,如结合QTd、Tp-Te能进一步提高预测能力。
Objective To investigate the predictive value of ischemic J waves on malignant ventricular arrhythmias in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 286 acute STEMI patients admitted to our hospital from June 2005 to July 2010 were enrolled in the study. 41 cases of ischemic J wave were recorded on the body surface electrocardiogram (ECG) at admission, and no ischemic J wave was recorded 245 cases as control group. The incidence of malignant ventricular arrhythmias and QT, QTd and Tp-Te in patients with malignant ventricular arrhythmia in two groups were compared between the two groups after admission for 48 hours. Results The incidence of malignant ventricular arrhythmia was significantly higher in the observation group than in the control group (P <0.05). The QTd and Tp-Te in the observation group were significantly longer than those in the control group (P <0.01) (P> 0.05). QTd and Tp-Te in patients with malignant ventricular arrhythmia in the observation group were significantly longer than those in the same group without malignant ventricular arrhythmia (all P <0.01). Conclusions The incidence of malignant ventricular arrhythmia is increased when ischemic J wave appears in patients with acute STEMI. It can be used as a predictor of malignant ventricular arrhythmia in patients with acute STEMI. For example, QTd and Tp-Te can further improve the predictive ability.