ST段抬高型急性心肌梗死合并J波综合征患者的心电图特征
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摘要
目的:探讨ST段抬高型急性心肌梗死(STEMI)并发J波综合征患者的心电图特征及意义。方法:从我院收治的STEMI患者中筛选出300例作为研究对象,其中出现J波综合征的有59例(J波综合征组),未出现J波综合征的有241例(无J波综合征组)。J波综合征组又根据存活情况分为死亡组(12例)和存活组(47例)。测量患者入院第一次所做的12导联心电图每个导联的QT间期,找出其QT间期的最小值及最大值,并计算其离散度(QTd)。记录两组患者出现室性心律失常、死亡及梗死部位等情况。结果:J波综合征组QTd明显大于无J波综合征组[(52±25)ms比(47±22)ms,P=0.003]。与无J波综合征组比较,J波综合征组发生室性心律失常(16.6%比30.5%)、死亡率(6.6%比20.3%)、前壁心梗(44.8%比76.3%)发生率明显升高。在J波综合征组中,与存活组比较,死亡组QT间期最小值明显减小[(363±33)ms比(319±31)ms],QTd[(45±22)ms比(80±22)ms]值明显增大(P<0.05或<0.01)。结论:ST段抬高型急性心肌梗死并发J波综合征的原因可能与QTd增大有关,并发J波综合征将会导致严重心律失常、死亡的风险增加。
Objective:To analyze ECG features of patients with ST elevation acute myocardial infarction(STEMI)complicated J wave syndrome(JWS),and its significance.Methods:A total of 300 STEMI patients treated in our hospital were screened,including 59 cases with JWS(JWS group)and 241 cases without JWS(no JWS group).According to survival condition,JWS group was divided into death group(n=12)and survival group(n=47).QT interval of every lead on the first 12-lead ECG examination after hospitalization was measured,and minimum and maximum value of QT interval were discovered,then QT interval dispersion(QTd)was calculated.Incidence of ventricular arrhythmia,death and infarct location were recorded in two groups.Results:QTd of JWS group was significantly longer than that of no JWS group[(52±25)ms vs. (47±22)ms,P=0.003].Compared with no JWS group,there were significant rise in incidence rates of ventricular arrhythmia(16.6% vs. 30.5%),death(6.6%vs. 20.3%)and anterior wall myocardial infarction(44.8% vs. 76.3%)in JWS group.In JWS group,compared with survival group,there was significant reduction in minimum value of QT interval[(363±33)ms vs. (319±31)ms]and significant rise in QTd[(45±22)ms vs. (80±22)ms]in death group.P<0.05 or<0.01.Conclusion:The cause of STEMI complicated J wave syndrome may be related to increased QTd.It complicated J wave syndrome will lead to increased risk of serious arrhythmias and death.
Objective:To analyze ECG features of patients with ST elevation acute myocardial infarction(STEMI)complicated J wave syndrome(JWS),and its significance.Methods:A total of 300 STEMI patients treated in our hospital were screened,including 59 cases with JWS(JWS group)and 241 cases without JWS(no JWS group).According to survival condition,JWS group was divided into death group(n=12)and survival group(n=47).QT interval of every lead on the first 12-lead ECG examination after hospitalization was measured,and minimum and maximum value of QT interval were discovered,then QT interval dispersion(QTd)was calculated.Incidence of ventricular arrhythmia,death and infarct location were recorded in two groups.Results:QTd of JWS group was significantly longer than that of no JWS group[(52±25)ms vs. (47±22)ms,P=0.003].Compared with no JWS group,there were significant rise in incidence rates of ventricular arrhythmia(16.6% vs. 30.5%),death(6.6%vs. 20.3%)and anterior wall myocardial infarction(44.8% vs. 76.3%)in JWS group.In JWS group,compared with survival group,there was significant reduction in minimum value of QT interval[(363±33)ms vs. (319±31)ms]and significant rise in QTd[(45±22)ms vs. (80±22)ms]in death group.P<0.05 or<0.01.Conclusion:The cause of STEMI complicated J wave syndrome may be related to increased QTd.It complicated J wave syndrome will lead to increased risk of serious arrhythmias and death.
引文
[1]王东琦,杨海涛,李红兵,等.ST段抬高型急性心肌梗死合并J波综合征患者的心电图特征[J].山西医科大学学报,2008,39(3):235-237.
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[3]Yan GX,Joshi A,Guo D,et al.Phase 2reentry as a trigger to initiate ventricular fibrillation during early acute myocardial ischemia[J].Circulation,2004,110(9):1036-1041.
[4]苏显明,何亚军,王东琦,等.ST段抬高型急性心肌梗死出现J波综合征的临床特点分析[J].中国现代医学杂志,2009,19(13):2041-2047.
[5]Merchant FM,Nose worthy PA,Weiner BB.et al.Ability of terminal QRS nothing to distinguish begign from malignant electrocardiographic forms of early repolarizafion[J].Am J Cardiol,2009,104(10):1402-1404.
[6]吴泽奎,曾辰华,荣根满.急性心肌梗死QT间期离散度与合并室性心律失常的关系研究分析[J].中国医药指南,2015,13(23):99-100.
[7]陈义汉,龚兰生.Q-T离散度[J].中华心血管杂志,1995,23(4):307.
[8]Yan GX,Joshi A,Guo DL,etal.Phase2reentryasatrigger to in itiateventricular fibrillation duringearly acutemyocardialis chemia[J].Circulation,2004,110(9):1036-1041.
[9]中华医学会心血管病学分会,中华心血管病杂志编辑委员会,《中国循环杂志》编辑委员会.急性心肌梗死诊断和治疗指南[J].中华心血管病杂志,2001,29(12):710-725.
[10]Boden WE.Interpreting new treatment guidelines for non-STsegment elevation acute coronary syndromes[J].Am J Cardiol,2001,88(8A):19-24.
[11]Azzarelli S,Galassi AR,Amico F,et al.Clinical features of transient left ventricular apical ballooning[J].Am J Cardiol,2006,98(9):1273-1276.
[12]Sridharan MR,Horan LG.Electrocardiographic J wave of hypercalcemia[J].Am J Cardiol,1984,54(6):672-673.
[13]Yan Gan-Xin,Antzelevitch C.Cellular Basis for the Electrocardiographic J wave[J].Circulation,1996,93(2):372-379.
[14]Antzelevitch C,Sicouri S,Litovsky SH,et al.Heterogeneity within theventricular wall:electrophysiology and pharmacology of epicardial,endocardial,and M cell[J].Circ Res,1991,69(6):1427-1447.
[15]Yan GX,Antzelevitch C.Cellular basis for the Brugada Syndrome and other mechanisms of arrhythmo genesis associated with ST-segment elevation[J].Circulation,1999,100(15):1660-1666.
[16]王志娟.病毒性心肌炎患者QT离散度的临床意义[J].中国现代药物应用,2015,9(11):68-69.
[17]Maruyama M,A tarashi H,Ino T,et al.Osborn waves associated with ventricular fibrillation in apatient with vasospasmticangina[J].J Cardiovasc Electrophysiol,2002,13(5):486-489.
[18]Kuo CS,Munakata K,Reddy CP,etal.Characteristicsandpossible Mechanism of ventricular arrhythmia dependenton the dispersion of action potential durations[J].Circulation,1983,67:1356-1367.
[2]严干新,姚青海,王东琦,等.J波与J波综合征[J].中华心律失常学杂志,2004,8(6):360-365.
[3]Yan GX,Joshi A,Guo D,et al.Phase 2reentry as a trigger to initiate ventricular fibrillation during early acute myocardial ischemia[J].Circulation,2004,110(9):1036-1041.
[4]苏显明,何亚军,王东琦,等.ST段抬高型急性心肌梗死出现J波综合征的临床特点分析[J].中国现代医学杂志,2009,19(13):2041-2047.
[5]Merchant FM,Nose worthy PA,Weiner BB.et al.Ability of terminal QRS nothing to distinguish begign from malignant electrocardiographic forms of early repolarizafion[J].Am J Cardiol,2009,104(10):1402-1404.
[6]吴泽奎,曾辰华,荣根满.急性心肌梗死QT间期离散度与合并室性心律失常的关系研究分析[J].中国医药指南,2015,13(23):99-100.
[7]陈义汉,龚兰生.Q-T离散度[J].中华心血管杂志,1995,23(4):307.
[8]Yan GX,Joshi A,Guo DL,etal.Phase2reentryasatrigger to in itiateventricular fibrillation duringearly acutemyocardialis chemia[J].Circulation,2004,110(9):1036-1041.
[9]中华医学会心血管病学分会,中华心血管病杂志编辑委员会,《中国循环杂志》编辑委员会.急性心肌梗死诊断和治疗指南[J].中华心血管病杂志,2001,29(12):710-725.
[10]Boden WE.Interpreting new treatment guidelines for non-STsegment elevation acute coronary syndromes[J].Am J Cardiol,2001,88(8A):19-24.
[11]Azzarelli S,Galassi AR,Amico F,et al.Clinical features of transient left ventricular apical ballooning[J].Am J Cardiol,2006,98(9):1273-1276.
[12]Sridharan MR,Horan LG.Electrocardiographic J wave of hypercalcemia[J].Am J Cardiol,1984,54(6):672-673.
[13]Yan Gan-Xin,Antzelevitch C.Cellular Basis for the Electrocardiographic J wave[J].Circulation,1996,93(2):372-379.
[14]Antzelevitch C,Sicouri S,Litovsky SH,et al.Heterogeneity within theventricular wall:electrophysiology and pharmacology of epicardial,endocardial,and M cell[J].Circ Res,1991,69(6):1427-1447.
[15]Yan GX,Antzelevitch C.Cellular basis for the Brugada Syndrome and other mechanisms of arrhythmo genesis associated with ST-segment elevation[J].Circulation,1999,100(15):1660-1666.
[16]王志娟.病毒性心肌炎患者QT离散度的临床意义[J].中国现代药物应用,2015,9(11):68-69.
[17]Maruyama M,A tarashi H,Ino T,et al.Osborn waves associated with ventricular fibrillation in apatient with vasospasmticangina[J].J Cardiovasc Electrophysiol,2002,13(5):486-489.
[18]Kuo CS,Munakata K,Reddy CP,etal.Characteristicsandpossible Mechanism of ventricular arrhythmia dependenton the dispersion of action potential durations[J].Circulation,1983,67:1356-1367.