心电图aVR导联ST段变化对非ST段抬高型急性冠脉综合征患者的影响

摘要
图/表
参考文献(18)
相关文章 (15)

全文: PDF (498 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨心电图aVR导联ST段变化对非ST段抬高型急性冠脉综合征（NSTE-ACS）患者的影响。方法回顾性选取2019年7月至2020年7月大连医科大学附属第一医院收治的168 例NSTE-ACS 患者作为研究对象，根据患者入院发病时测量的心电图aVR 导联ST 段抬高程度分为非STaVR 段抬高组（65 例）、STaVR 段抬高0.05～＜0.1 mV 组（58 例）与STaVR 段抬高≥0.1 mV 组（45 例）。记录三组患者临床资料及6 个月内主要心脏不良事件（MACE）发生情况并进行统计学分析。结果三组患者的心肌梗死史、左心射血分数（LVEF）、Killip 分级、病变血管支数及治疗方案比较，差异有统计学意义（P＜0.05）。三组患者心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CKMB）、脑钠肽（BNP）及超敏C 反应蛋白（hs-CRP）水平比较，差异有统计学意义（P＜0.05）；STaVR 段抬高≥0.1 mV组、STaVR 段抬高0.05～＜0.1 mV 组的cTnI、CK-MB、BNP 及hs-CRP 水平高于非STaVR 段抬高组，STaVR 段抬高≥0.1 mV 组高于STaVR 段抬高0.05～＜0.1 mV 组，差异有统计学意义（P＜0.05）。三组患者6 个月内（再发）心肌梗死、心血管死亡及血运重建发生率比较，差异有统计学意义（P＜0.05）；STaVR 段抬高≥0.1 mV 组、STaVR 段抬高0.05～＜0.1 mV 组的（再发）心肌梗死、心血管死亡及血运重建发生率高于非STaVR 段抬高组，STaVR 段抬高≥0.1 mV 组高于STaVR 段抬高0.05～＜0.1 mV 组，差异有统计学意义（P＜0.05）。6 个月内发生与未发生MACE 的NSTE-ACS 患者在非STaVR 段抬高、STaVR 段抬高0.05～＜0.1 mV 及STaVR 段抬高≥0.1 mV 的分布情况比较，差异有统计学意义（P＜0.05）。多因素logistic 回归分析结果显示，LVEF（β=0.288，OR=1.586，95%CI=1.267～2.831）、Killip 分级（β=0.271，OR=1.716，95%CI=1.359～2.498）、病变血管支数（β=0.743，OR=2.247，95%CI=1.664～3.576）、cTnI（β=0.553，OR=2.093，95%CI=1.537～3.498）、CK-MB（β=1.105，OR=2.358，95%CI=1.239～3.869）、BNP（β=0.934，OR=1.529，95%CI=0.913～2.722）、hs-CRP（β=0.326，OR=1.768，95%CI=1.175～2.246）及STaVR 段抬高（β=0.179，OR=1.452，95%CI=1.123～2.051）为NSTE-ACS 患者6 个月内发生MACE 的独立危险因素（P＜0.05）。结论心电图STaVR 段抬高≥0.1 mV 的NSTE-ACS 患者6 个月内MACE 发生率较高，且心电图STaVR 段抬高是NSTE-ACS 患者发生MACE 的独立危险因素，应引起高度关注。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	秦园生
	唐秀娥

关键词 ：心电图, aVR 导联, 非ST 段抬高型急性冠脉综合征, 主要心脏不良事件

Abstract：Objective To discuss the effect of ST segment changes in lead aVR of patients with non-ST-segment elevation acute coronary syndrome(NSTE-ACS).Methods A total of 168 patients with NSTE-ACS in the First Affiliated Hospital of Dalian Medical University from July 2019 to July 2020 were analyzed retrospectively,and divided into the non STaVR segment elevation group(65 cases),STaVR segment elevation 0.05-0.1 mV group(58 cases)and STaVR segment elevation ≥0.1 mV group(45 cases)according to the ST segment degree of improvement in lead aVR measurements at admission.The baseline data,occurrence of MACE within 6 months of three groups of patients were recorded and analyzed.Results The history of myocardial infarction,left ventricular ejection fraction(LVEF),Killip grade,number of diseased vessels and treatment regimen of the three groups were significant differences(P＜0.05).The cTnI,CK-MB,BNP and hs-CRP levels of the three groups were significant differences(P＜0.05);The cTnI,CK-MB,BNP and hs-CRP levels of STaVR segment elevation ≥0.1 mV group and STaVR segment elevation 0.05-0.1 mV group were higher than those of the non STaVR segment elevation group,the STaVR segment elevation ≥0.1 mV group were higher than the STaVR segment elevation 0.05-0.1 mV group,and the differences were statistically significant(P＜0.05).The(repeat)myocardial infarction,cardiovascular death and revascularization incidence rates of the three groups within 6 months were significant different(P＜0.05).The(repeat)myocardial infarction,cardiovascular death and revascularization incidence rates of the STaVR segment elevation ≥0.1 mV group and the STaVR segment elevation 0.05-0.1 mV group were higher than those of the non STaVR segment elevation group,the STaVR segment elevation ≥0.1 mV group were higher than the STaVR segment elevation 0.05-0.1 mV group,the differences were statistically significant(P＜0.05).The distribution of non STaVR segment elevation,STaVR segment elevation 0.05-0.1 mV and STaVR segment elevation ≥0.1 mV of NSTE-ACS patients MACE occurrence or not within 6 months were significant differences(P＜0.05).Multivariate logistic regression analysis showed that the LVEF(β=0.288,OR=1.586,95%CI=1.267-2.831),Killip classification(β=0.271, OR=1.716,95%CI=1.359-2.498),number of vessel branches(β=0.743, OR=2.247,95%CI=1.664-3.576),cTnI(β=0.553, OR=2.093,95%CI=1.537-3.498),CK-MB(β=1.105, OR=2.358,95%CI=1.239-3.869),BNP(β=0.934, OR=1.529,95%CI=0.913-2.722),hs-CRP(β=0.326, OR=1.768,95%CI=1.175-2.246)and STaVR segment elevation(β=0.179, OR=1.452,95%CI=1.123-2.051)were independent risk factors for MACE occurs within 6 months of NSTE-ACS patients(P＜0.05).Conclusion The MACE incidence of NSTE-ACS patients with electrocardiogram STaVR segment elevation ≥0.1 mV is higher,moreover STaVR segment elevation is the independent risk factors for MACE occurs within 6 months in NSTE-ACS patients,which should be paid much attention.

Key words： Electrocardiogram Lead aVR Non-ST-segment elevation acute coronary syndrome Major adverse cardiac events

引用本文:

秦园生;唐秀娥. 心电图aVR导联ST段变化对非ST段抬高型急性冠脉综合征患者的影响[J]. 中国当代医药, 2022, 29(10): 62-66转70.
QIN Yuansheng;TANG Xiu'e. Effect of ST segment changes in lead aVR of patients with non-ST- segment elevation acute coronary syndrome. 中国当代医药, 2022, 29(10): 62-66转70.

链接本文:

https://www.dangdaiyiyao.com/CN/ 或 https://www.dangdaiyiyao.com/CN/Y2022/V29/I10/62

[12]	杨欣.急性冠脉综合征合并心房颤动的抗栓治疗[J].现代医药卫生，2019，35（6）:870-873.
[13]	刘志红，王晓燕，籍振国，等.心电图aVR 导联ST 段变化对急性冠脉综合征患者临床风险的预测价值研究[J].中国全科医学，2015，18（15）：1733-1737.
[1]	吴魏芹，林振宇，陈云，等.aVR 导联ST 段改变的特征对NSTE-ACS 患者病变血管的预测价[J].中国循证心血管医学杂志，2016，8（7）：833-835，839.
[2]	Kim HL，Oh SW，Lee H，et al.Findings of single-photon emission computed tomography and its relation with quantitative coronary angiography in patients with significant stenosis of the left main coronaryartery[J].Korean J Radiol，2018，19（1）：101-110.
[3]	双莲，陈凤英，崔晓迎，等.非ST 段抬高型急性冠脉综合征患者心电图aVR 导联ST 段抬高与近期预后的相关性分析[J].现代生物医学进展，2016，16（5）：922-925，906.
[4]	张晓晖，曾伟.aVR 导联ST 段抬高结合肌钙蛋白I 预测非ST 段抬高型急性冠状动脉综合征患者预后[J].中国医药科学，2016，6（18）：11-14，24.
[5]	García Hernández RA，Rivero Seriel L.Prognostic value of ST segment in aVR lead in non-ST segment elevation acute coronary syndrome[J].Rev Fed Argent Cardiol，2018，47（3）：120-124.
[8]	中华医学会心血管病学分会.非ST 段抬高型急性冠状动脉综合征诊断和治疗指南（2016）[J].中华心血管病杂志，2017，45（5）：359-376.
[10]	刘湘华，梁力晖，唐铭翔.老年非ST 段抬高型急性冠脉综合征患者aVR 导联ST 段抬高与住院主要不良心脏事件的关系[J].川北医学院学报，2016，31（1）：51-54.
[11]	包萍，陶长生，朱晓非，等.急性冠脉综合征患者aVR 导联ST 段变化与冠状动脉Gensini 评分的相关性研究[J].临床军医杂志，2015，43（9）：909-912.
[6]	Qayyum H，Hemaya S，Squires J，et al.Recognising the de Winter ECG pattern-A time critical electrocardiographic diagnosis in the emergency department[J].J Electrocardiol，2018，51（3）：392-395.
[7]	D'Angelo C，Zagnoni S，Gallo P，et al.Electrocardiographic changes in patients with acute my-ocardial infarction caused by left main trunk occlusion[J].J Cardiovasc Med，2018，19（8）：439-445.
[9]	Miranda DF，Lobo AS，Walsh B，et al.New insights into the use of the 12-lead electrocardiogram for diagnosing acute myocardial infarction in the emergency department[J].Can J Cardiol，2018，34（2）：132-145.
[14]	Adar A，Onalan O，Cakan F.Relationship between ST-segment shifts in lead aVR and coronary complexity in patients with acute coronary syndrome[J].Acta Cardiol Sin，2019，35（1）：11-19.
[15]	Huerta P，Naranjo Gárate AM，Martínez D.Connection between electrocardiographic and cine-coronariographic studies in coronarydiseases[J].Int J Morphol，2018，36（4）：1514-1518.
[16]	宁丽君，牛俊红，王浩，等.碎裂QRS 波在急性冠脉综合征诊断及对预后的价值分析[J].中西医结合心脑血管病杂志，2017，15（8）：973-975.
[17]	刘红彬，张晓华，张志刚，等.体表心电图在冠状动脉粥样硬化性心脏病中的诊断价值[J].实用心电学杂志，2015，24（4）：256-260.
[18]	温静.心电图aVR 导联ST 段抬高对急性冠脉综合征患者长期预后的评估价值研究[J].实用心脑肺血管病杂志，2016，24（5）：31-34，38.