急性ST段抬高型心肌梗死患者术后碎裂QRS波的影响因素及其与心肌灌注和短期预后的关系分析

摘要 目的：探讨急性ST段抬高型心肌梗死（STEMI）患者术后碎裂QRS波（fQRS）的影响因素，分析其与心肌灌注及短期预后的关系。方法：选取上海中医药大学附属曙光医院宝山分院于2017年4月～2019年4月期间收治的108例STEMI患者的临床资料行回顾性研究，术后均行12导联心电图检查，根据有无fQRS，分成fQRS组（n=52），非fQRS组（n=56）。比较两组临床资料，经单因素及多因素Logistic回归分析明确患者术后fQRS的影响因素。比较两组心肌灌注情况，心肌灌注采用心肌呈色分级法（MBG）进行分析。随访1年，分析患者主要不良心血管事件发生率，包括心力衰竭、心绞痛、心源性死亡、心源性休克，用于评价短期预后。结果：单因素分析提示，年龄、冠脉血管病变支数、Gensini评分、心绞痛发作至血管开通时间与术后fQRS有关（P＜0.05）。多因素Logistic回归分析显示，年龄、冠脉血管病变支数、Gensini评分、心绞痛发作至血管开通时间为术后fQRS的影响因素（P＜0.05）。fQRS组MBG 3级占比为46.15%，显著低于非fQRS组的76.79%（P＜0.05）。fQRS组不良心血管事件发生率为26.92%，显著高于非fQRS组的10.71%（P＜0.05）。结论：STEMI患者术后fQRS发生的影响因素包括年龄、冠脉血管病变支数、Gensini评分以及心绞痛发作至血管开通时间，且术后fQRS可预测心肌灌注情况及增加不良心血管事件发生率。

Influencing Factors of Post-operative Fragmented QRS Complex and Its Relationship with Myocardial Perfusion and short-term Prognosis in Patients with Acute ST Segment Elevation Myocardial Infarction

ABSTRACT Objective: To investigate the influencing factors of post-operative fragmented QRS complex (fQRS) in patients with acute ST segment elevation myocardial infarction (STEMI), and to analyze its relationship with myocardial perfusion and short-term prognosis. Methods: 108 patients with STEMI in Baoshan Branch of Shuguang Hospital Affiliated to Shanghai University of traditional Chinese Medicine from April 2017 to April 2019 were selected for retrospective study. All patients underwent 12 lead electrocardiogram examination after operation, according to the presence or absence of fQRS, they were divided into fQRS group (n=52), non-fQRS group (n=56). The clinical data of the two groups were compared, and the Univariate and multivariate logistic regression analysis was used to determine the influencing factors of postoperative fQRS. Myocardial perfusion was compared between the two groups. Myocardial perfusion was analyzed using myocardial blush grades (MBG). Followed up for 1 year, the incidence of major adverse cardiovascular events, including heart failure, angina pectoris, cardiogenic death, and cardiogenic shock were analyzed, and it is used to evaluate the short-term prognosis. Results: Univariate analysis suggested that age, number of coronary vascular lesions, Gensini score, and angina pectoris attack to vascular opening time were related to postoperative fQRS (P<0.05). Multivariate logistic regression analysis showed that age, number of coronary vascular lesions, Gensini score, angina pectoris attack to vascular opening time were the influencing factors of postoperative fQRS (P<0.05). The proportion of MBG 3 grades in the fQRS group was 46.15%, which was significantly lower than 76.79% in the non-fQRS group (P<0.05). The incidence of adverse cardiovascular events in the fQRS group was 26.92%, which was significantly higher than 10.71% in the non-fQRS group (P<0.05). Conclusion: Influencing factors of postoperative fQRS in patients with STEMI include age, number of coronary vascular lesions, Gensini score, and angina pectoris attack to vascular opening time, and postoperative fQRS can predict myocardial perfusion and increase the incidence of adverse cardiovascular events.