摘要
目的：分析QRS波积分对ST段抬高型急性心肌梗死（STEMI）患者近期心功能不全及心源性猝死（SCD）的预测作用。方法：收集在心内科住院的STEMI患者80例,无束支传导阻滞及起搏器置入,随访6个月,记录其入院时及出院前标准12导联心电图,用Selvester积分系统方法分为QRS积分≤3组和QRS积分〉3组,比较两组临床特点,生化检查：血BNP,心脏超声检查,6个月内患者因心功能不全住院次数及SCD发生率,应用统计学软件进行分析。结果：QRS积分≤3组共52例,平均年龄（61.4±13.1）岁;QRS积分〉3组共28例,平均年龄（71.6±11.4）岁,两组比较差异有统计学意义（P〈0.05）;与QRS积分≤3组比较,QRS积分〉3组患者心率显著增快[（78.96±15.06）次/min∶（72.0±12.5）次/min,P〈0.05],非下壁心肌梗死组显著增多（72.7%∶60.0%,P〈0.05）;QRS积分≤3组在半年年内未发生SCD,QRS积分〉3组在半年内发生SCD/心力衰竭（心衰）者10例,占该组的35.7%,两组之间差异有统计学意义（P〈0.05）,给予多变量分析后QRS波积分是急性心肌梗死患者心衰/SCD的独立危险因素（OR1.52,95%CI：1.03~2.10,P〈0.01）。结论：QRS积分是STEMI患者近期预后（心功能不全及SCD）独立的预测因子。
Objective：To evalurate the predictive value of QRS score on patients with STEMI who have had sudden cardiac death or failure within 6 months.Method：We prospectively followed up 80 consecutive survivors of ST-elevation myocardial infarction（STEMI）without bundle branch block or paced rhythm at hospital discharge for 6months.The modified 32-point QRS score was calculated as a part of the predischarge evaluation.The predefined primary endpoint was the composite of death or hospitalization for heart failure by 6 months.Result：There were 52 patients in QRS score≤3 group and 28 patients in QRS〉3 group.The mean age of the groups were（61.4±13.1）years and（71.6±11.4）years respectively.The results from these two groups were statistically significant（P〈0.05）.Compared to measured heart rate,the heart rate in QRS score≤3 group（78.96±15.06）beat/min was faster than in QRS score〉3 group（72.00±12.50beat/min,P〈0.05）.Adverse outcomes occurred more often in patients with higher QRS scores.Ten patients（35.7%）developed sudden cardiac death or heart failure in QRS score〉3 group within 6 months.After adjusting for baseline characteristics,the high QRS score remained a strong factor in the prediction of heart-failure free survival during the follow-up period.In multivariate models,the QRS score was an independent predictor of outcome（OR1.52,95%CI：1.03-2.10,P〈0.01）.Conclusion：For patients surviving a STEMI,the predischarge QRS score provides powerful prognostic information on short-term outcomes,including mortality and readmission.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2016年第2期147-150,共4页
Journal of Clinical Cardiology
