缺血性J波对急性心肌梗死预后的预测价值
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摘要
目的探讨缺血性J波对急性心肌梗死患者预后的预测价值。方法选取2015年6月至2018年6月在我院住院治疗的177例急性心肌梗死患者,根据心电图上是否出现缺血性J波分为J波组(57例)和非J波组(120例)。基于心电图和冠脉造影结果,比较和分析两组心肌梗死累及部位、冠脉血管病变部位和心律失常发生情况;再进行影响心肌梗死伴缺血性J波患者预后的单因素分析和Logistic回归分析。结果 J波组前壁急性梗死的发生率显著高于非J波组(75.44% vs.34.17%,P <0.05)。J波组中累及右冠脉严重病变者占比明显高于非J波组(59.6% vs.29.2%,P <0.05)。J波组室速或室颤的发生率显著高于非J波组(29.82% vs.7.50%,P <0.05)。年龄、梗死累及右冠脉血管为影响急性心肌梗死伴缺血性J波患者预后的相关危险因素(OR> 1)。结论缺血性J波与急性心肌梗死发生部位、累及血管、年龄之间具有相关性。缺血性J波的出现预示着恶性室性心律失常事件的发生率较高且预后不良,可作为心脏性猝死的高危预警指标之一,建议临床上对这类患者积极采取相关防治措施。
Objective To explore the predictive value of ischemic J-wave on the prognosis of patients with cute myocardial infarction. Methods A total of 177 patients with acute myocardial infarction were selected who had been admitted in our hospital from June 2015 to June 2018. According to the appearance of J-wave on ECG,these patients were divided into J-wave group(57 cases) and non-J-wave group(120 cases). With ECG report and coronary angiography results,the involved site of myocardial infarction,site of coronary artery lesion,and incidence of arrhythmias were compared and analyzed between the two groups. Single factor analysis and Logistic regression analysis were performed on the influential factors for the prognosis of myocardial infarction complicated by ischemic J-wave. Results The incidence of anterior wall acute infarction in J-wave group was significantly higher than that in non-J-wave group(75. 44% vs. 34. 17%,P < 0. 05). The proportion of those with severe right coronary artery lesions in J-wave group was significantly higher than that in non-J-wave group(59. 6% vs. 29. 2%,P < 0. 05).The incidence of ventricular tachycardia or ventricular fibrillation in J-wave group was significantly higher than that in non-J-wave group(29. 82% vs. 7. 50%,P < 0. 05). Age and infarction involving right coronary artery were related risk factors influencing the prognosis of the patients with acute myocardial infarction complicating ischemic J-wave. Conclusion The appearance of ischemic J-wave is correlated with the site of acute myocardial infarction,involved blood vessel and age. It indicates a high incidence of malignant ventricular arrhythmia and poor prognosis,which could serve as one of the high-risk early-warning indexes for sudden cardiac death. For these patients,it is suggested to take active measures to prevent and control the appearance of ischemic J-wave in clinical practice.
Objective To explore the predictive value of ischemic J-wave on the prognosis of patients with cute myocardial infarction. Methods A total of 177 patients with acute myocardial infarction were selected who had been admitted in our hospital from June 2015 to June 2018. According to the appearance of J-wave on ECG,these patients were divided into J-wave group(57 cases) and non-J-wave group(120 cases). With ECG report and coronary angiography results,the involved site of myocardial infarction,site of coronary artery lesion,and incidence of arrhythmias were compared and analyzed between the two groups. Single factor analysis and Logistic regression analysis were performed on the influential factors for the prognosis of myocardial infarction complicated by ischemic J-wave. Results The incidence of anterior wall acute infarction in J-wave group was significantly higher than that in non-J-wave group(75. 44% vs. 34. 17%,P < 0. 05). The proportion of those with severe right coronary artery lesions in J-wave group was significantly higher than that in non-J-wave group(59. 6% vs. 29. 2%,P < 0. 05).The incidence of ventricular tachycardia or ventricular fibrillation in J-wave group was significantly higher than that in non-J-wave group(29. 82% vs. 7. 50%,P < 0. 05). Age and infarction involving right coronary artery were related risk factors influencing the prognosis of the patients with acute myocardial infarction complicating ischemic J-wave. Conclusion The appearance of ischemic J-wave is correlated with the site of acute myocardial infarction,involved blood vessel and age. It indicates a high incidence of malignant ventricular arrhythmia and poor prognosis,which could serve as one of the high-risk early-warning indexes for sudden cardiac death. For these patients,it is suggested to take active measures to prevent and control the appearance of ischemic J-wave in clinical practice.
引文
[1]郭继鸿.J波综合征:缺血性J波[J].临床心电学杂志,2014,23(5):328-331.
[2]吴蔚,杨希立,刘宇清,等.急性冠脉综合征缺血性J波的临床意义[J].临床心电学杂志,2013,22(4):254-25.
[3]朱从飞.缺血性J波预测急性心肌梗死后恶性室性心律失常发生的价值[J].实用临床医学,2016,17(3):16-17.
[4]樊雪婷,韩梦晶,买力旦木·艾克拜.缺血性J波的特征及临床意义[J].实用心电学杂志,2017,26(3):222-225.
[5]董海秋,董梅,任法新.雌激素水平对绝经后女性急性心肌梗死发生的影响研究[J].临床心血管病杂志,2017,33(2):153-156.
[6]刘强,杨小梅,韩乾国.急性ST段抬高型心肌梗死患者心电图特征临床分析[J].医学与哲学,2015,36(8B):32-34.
[2]吴蔚,杨希立,刘宇清,等.急性冠脉综合征缺血性J波的临床意义[J].临床心电学杂志,2013,22(4):254-25.
[3]朱从飞.缺血性J波预测急性心肌梗死后恶性室性心律失常发生的价值[J].实用临床医学,2016,17(3):16-17.
[4]樊雪婷,韩梦晶,买力旦木·艾克拜.缺血性J波的特征及临床意义[J].实用心电学杂志,2017,26(3):222-225.
[5]董海秋,董梅,任法新.雌激素水平对绝经后女性急性心肌梗死发生的影响研究[J].临床心血管病杂志,2017,33(2):153-156.
[6]刘强,杨小梅,韩乾国.急性ST段抬高型心肌梗死患者心电图特征临床分析[J].医学与哲学,2015,36(8B):32-34.