急性心肌梗死患者心电图碎裂QRS波与左心室收缩功能、心率变异性及心脏事件的关系研究

目的:探讨急性心肌梗死患者心电图碎裂QRS(f QRS)波与左心室收缩功能、心率变异性及心脏事件的关系。方法:收集2018年1月～2020年1月期间于本院进行治疗的急性心肌梗死患者124例,对患者行心电图检查,根据患者心电图是否出现f QRS波分成f QRS组(59例)和无f QRS组(65例),采用多普勒超声诊断仪对两组患者的左心室收缩功能进行检测对比,并对两组患者进行24h动态心电图检查,对两组患者的心率变异性指标进行统计对比。对两组患者进行为期3个月的随访观察,统计对比两组患者随访期间心脏事件的发生率。结果:f QRS组患者的左室射血分数(LVEF)低于无f QRS组,左心室舒张末期容积(LVEDV)、左心室舒张末期内径(LVEDD)均高于无f QRS组(P0.05)。f QRS组患者总标准差(SDNN)、两个相邻RR间期互差(PNN50)、差值均方根(RMSSD)均低于无f QRS组(P0.05)。随访期间f QRS组患者的心脏事件发生率为35.59%(21/59),高于无f QRS组患者的13.85%(9/65)(P0.05)。结论:伴有心电图f QRS波急性心肌梗死患者的左心室收缩功能降低,心率变异性指标降低,且心脏不良事件发生率增加,心电图f QRS波在一定程度上可作为急性心肌梗死患者心功能、心率变异性及心脏事件发生的监测手段。

Study on the Relationship between Fragmented QRS Wave of Electrocardiogram and Left Ventricular Systolic Function, Heart Rate Variability and Cardiac Events in Patients with Acute Myocardial Infarction

ABSTRACT Objective: To study the relationship between the fragmented QRS wave of electrocardiogram (fQRS) and left ventricular systolic function, heart rate variability and cardiac events in patients with acute myocardial infarction. Methods: A total of 124 patients with acute myocardial infarction who were treated in our hospital from January 2018 to January 2020 were collected. The patients were examined by electrocardiogram examination, the patients were divided into two groups according to the presence or absence of fQRS in electrocardiogram: fQRS group (59 cases) and nun-fQRS group (65 cases). The systolic function of left ventricle in the two groups was detected and compared by Doppler ultrasound, 24-hour Holter was performed in the two groups, the heart rate variability indexes of the two groups were compared statistically. The patients in the two groups were followed up for 3 months, and the incidence of cardiac events during the follow-up was statistically compared. Results: The left ventricular ejection fraction (LVEF) of fQRS group was lower than that of non-fQRS group, and the left ventricular end diastolic volume (LVEDV) and left ventricular end diastolic diameter (LVEDD) were both higher than those of non-fQRS group (P<0.05). In the fQRS group, the total standard deviation (SDNN), the interphase interdifference between two adjacent RRS (PNN50), and the root mean square of difference (RMSSD) were all lower than those those of non-fQRS group (P<0.05). During the follow-up period, the incidence of cardiac events was 35.59%(21/59) in the fQRS group, which was higher than 13.85%(9/65) of non-fQRS group (P<0.05). Conclusion: In patients with acute myocardial infarction accompanied by electrocardiogram fQRS, left ventricular systolic function decreased, heart rate variability index decreased, and the incidence of cardiac adverse events increased. To some extent, electrocardiogram fQRS can be used as a monitoring method for cardiac function, heart rate variability and cardiac events in patients with acute myocardial infarction.