本文選題：冠心病 + 冠脈造影�。� 參考：《昆明醫(yī)科大學(xué)》2016年碩士論文

【摘要】：[目的]冠狀動(dòng)脈粥樣硬化性心臟病(Coronary atherosclerotic heart disease, CHD)簡(jiǎn)稱(chēng)冠心病,是由于脂質(zhì)代謝異常,血液中的脂質(zhì)沉著在原本光滑的冠狀動(dòng)脈內(nèi)膜上形成粥樣斑塊,粥樣斑塊沉積造成冠狀動(dòng)脈管腔狹窄或閉塞,導(dǎo)致心肌缺血缺氧或壞死而引起的心臟代謝及功能異常。隨著我國(guó)物質(zhì)生活水平提高、工作壓力增大、生活方式不合理、人口老齡化等社會(huì)問(wèn)題日益凸顯,冠心病的發(fā)病率呈明顯上升趨勢(shì)及年輕化趨勢(shì),是目前嚴(yán)重威脅我國(guó)中老年健康的心血管疾病之一,其預(yù)后及并發(fā)癥的發(fā)生主要與冠狀動(dòng)脈病變部位、程度及病變范圍相關(guān),早期發(fā)現(xiàn)病變并評(píng)估病情,進(jìn)行及時(shí)有效的治療對(duì)改善患者預(yù)后、控制疾病發(fā)展、延長(zhǎng)生存時(shí)間、提高生活質(zhì)量等起到至關(guān)重要的作用。目前,經(jīng)皮冠狀動(dòng)脈造影因其準(zhǔn)確性、直觀性等,是診斷冠心病的金標(biāo)準(zhǔn)。但屬于有創(chuàng)性的檢查,費(fèi)用較高,對(duì)操作者有著專(zhuān)業(yè)技術(shù)要求,且具有一定的風(fēng)險(xiǎn)性,故其在人群中的普及尚有阻力。標(biāo)準(zhǔn)體表十二導(dǎo)聯(lián)心電圖(ECG)發(fā)展歷史悠久,鑒于其快速、有效、便捷、價(jià)廉、無(wú)創(chuàng)及可重復(fù)性等優(yōu)點(diǎn),在冠心病的診斷中占有不可或缺的重要地位。當(dāng)心肌缺血、壞死或瘢痕組織形成時(shí),心室肌細(xì)胞發(fā)生除極與傳導(dǎo)延遲和緩慢,在心電圖上形成形態(tài)不規(guī)整的QRS波,即碎裂QRS波(Fragmentation QRS complex, fQRS)。本研究的目的在于通過(guò)分析冠心病患者fQRS的出現(xiàn)與冠狀動(dòng)脈病變情況的關(guān)系,了解fQRS在冠心病的診斷及病情評(píng)估方面的應(yīng)用價(jià)值,指導(dǎo)冠心病的臨床診治。[方法]本研究收集了2015年01月至2015年12月入住玉溪市人民醫(yī)院心內(nèi)科治療的患者486例,所有患者均行冠狀動(dòng)脈造影檢查,并完善心臟彩色多普勒超聲、靜息心電圖及相關(guān)血生化檢查,且排除了存在束支及室內(nèi)傳導(dǎo)阻滯、心電圖預(yù)激圖形、起搏器植入、電解質(zhì)紊亂、心室肥厚、先天性心臟結(jié)構(gòu)異常、心肌病等影響研究結(jié)果的病例。根據(jù)檢查結(jié)果按冠狀動(dòng)脈病變程度分為冠心病組(狹窄≥50%)和非冠心病組(狹窄50%),根據(jù)是否出現(xiàn)fQRS波,分為fQRS組和無(wú)fQRS組。根據(jù)Gensini評(píng)分分為40分、40-80分、80分三組。根據(jù)三支主支冠脈血管及其分支狹窄最重部位的狹窄程度分為50%、50-74%、75-99%、完全閉塞組。根據(jù)病變血管分為前降支病變、回旋支病變、右冠病變。綜合所有數(shù)據(jù)進(jìn)行碎裂QRS波的出現(xiàn)情況與冠狀動(dòng)脈病變范圍、狹窄程度、病變血管的相關(guān)性分析。[結(jié)果]本研究共有486例患者,其中明確診斷為冠心病者(冠脈病變程度≥50%)394例,非冠心病者(冠脈病變程度50%)92例。按是否出現(xiàn)fQRS分為fQRS組240例(冠心病220例)和無(wú)fQRS組246例(冠心病174例)。1冠狀動(dòng)脈病變范圍冠心病患者fQRS組與無(wú)fQRS組,兩組的各Gensini評(píng)分(40分組、40-80分組、80分組)病例所占比例分別為74人(33.6%)Vs 93人(53.4%)、88人(40.0%)Vs 51人(29.3%)、58人(26.4%)Vs 30人(17.2%),各比較組間均P0.05,差異有統(tǒng)計(jì)學(xué)意義。非冠心病組(狹窄50%),冠心病患者按Gensini評(píng)分分為40分組、40-80分組、80分組,比較4組間fQRS的檢出率分別為20人(21.7%)、74人(44.3%)、88人(63.3%)、58人(65.9%),除40-80分組與80分組間比較P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義外,余相鄰兩組間P0.05,差異有統(tǒng)計(jì)學(xué)意義。冠心病患者fQRS組按照Gensini評(píng)分40分組與40-80分組fQRS出現(xiàn)導(dǎo)聯(lián)數(shù)比較Z=-3.204,P=0.001；40-80分組與80分組fQRS出現(xiàn)導(dǎo)聯(lián)數(shù)比較Z=-3.676,P=0.000。2冠狀動(dòng)脈狹窄程度f(wàn)QRS組與無(wú)fQRS組的各狹窄程度(50%、50-74%、75-99%、完全閉塞)病例所占比例分別為20人(8.3%)Vs 72人(29.3%)、34人(14.2%)Vs 47人(19.1%)、107人(44.6%)Vs 96人(39.0%)、79人(32.9%)Vs 31人(12.6%),其中50%組、完全閉塞組P0.05,差異有統(tǒng)計(jì)學(xué)意義,余2組P≥0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。按狹窄程度分為50%組、50-74%組、75-99%組、完全閉塞組,比較4組間fQRS的檢出率分別為20人(21.7%)、34人(42.0%)、107人(52.7%)、 79人(71.8%),除50-74%組與75-99%組間比較P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義外,余相鄰兩組間P0.05,差異有統(tǒng)計(jì)學(xué)意義。冠心病患者fQRS組狹窄程度50-74%與75-99%相比較,fQRS出現(xiàn)導(dǎo)聯(lián)數(shù)Z=-2.414,P=0.000；75-99%與完全閉塞組相比較,fQRS出現(xiàn)導(dǎo)聯(lián)數(shù)比較Z=--3.970,P=0.000。3病變血管冠心病患者fQRS組與無(wú)fQRS組前降支、回旋支、右冠病變所占比例分別為197例(89.5%)Vs 158例(90.8%)、137例(62.3%)Vs 105例(60.3%)、166例(75.5%)Vs 118例(67.8%),各比較組間均P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。[結(jié)論]1.心電圖fQRS的出現(xiàn)對(duì)冠心病患者冠狀動(dòng)脈病變范圍及狹窄程度具有一定的預(yù)測(cè)價(jià)值,可協(xié)助臨床快速對(duì)冠心病患者進(jìn)行病情初步評(píng)估并選擇最合適的治療。2.冠心病患者fQRS出現(xiàn)的導(dǎo)聯(lián)數(shù)對(duì)冠脈病變程度及范圍亦有一定的預(yù)測(cè)價(jià)值。3.fQRS波對(duì)冠脈病變有一定的診斷價(jià)值,但尚不能因其出現(xiàn)的相應(yīng)導(dǎo)聯(lián)而明確相關(guān)病變血管。4.fQRS在成年男性的檢出率較女性為高。
[Abstract]:[Objective] coronary atherosclerotic heart disease (Coronary atherosclerotic heart disease, CHD) is referred to as coronary heart disease (CAD) for short. It is caused by abnormal lipid metabolism. The lipid deposits in the blood form atheromatous plaque on the original smooth coronary intima. Atherosclerotic plaque deposits cause the stenosis or occlusion of the coronary artery cavity, leading to myocardial ischemia and hypoxia. With the improvement of the level of material life, the increase of the working pressure, the irrational way of life, the aging of the population and other social problems, the incidence of coronary heart disease is on the rise and the trend of youth. It is one of the cardiovascular diseases that threaten the health of the middle-aged and the elderly in our country at present. The prognosis and complications are mainly related to the location, degree and extent of the coronary artery disease. Early detection and evaluation of the disease and timely and effective treatment will play an important role in improving the prognosis of the patients, controlling the development of the disease, prolonging the survival time, and improving the quality of life. Accuracy, intuition, and so on, is the gold standard for diagnosis of coronary heart disease. But it is a invasive examination, the cost is high, the operator has a professional technical requirement, and it has a certain risk, so it has a resistance in the popularity of the population. The standard body surface twelve lead electrocardiogram (ECG) has a long history, in view of its rapid, effective, convenient, cheap, and low price In the diagnosis of coronary heart disease, it plays an indispensable role in the diagnosis of coronary heart disease. When myocardial ischemia, necrosis or scar tissue is formed, the depolarization and conduction of the ventricular myocytes are delayed and slow, and the form of irregular QRS wave (Fragmentation QRS complex, fQRS) is formed on the electrocardiogram. The purpose of this study is the purpose of this study. In the analysis of the relationship between the appearance of fQRS and the coronary artery disease in patients with coronary heart disease, we know the value of fQRS in the diagnosis and evaluation of coronary heart disease and guide the clinical diagnosis and treatment of coronary heart disease. [Methods] this study collected 486 cases of patients who were treated in Department of Cardiology of Yuxi People's Hospital from 01 months to December 2015 from 01 months to December 2015. Coronary angiography was performed in all patients, and color Doppler echocardiography, resting electrocardiogram and related blood biochemical examination were perfected, and the results of the study were excluded from the results of the study, including the existence of bundle branch and indoor conduction block, electrocardiogram preexcitation pattern, pacemaker implantation, electrolyte disturbance, ventricular hypertrophy, congenital heart structure abnormalities, cardiomyopathy and so on. According to the degree of coronary artery disease, according to the degree of coronary artery disease, it was divided into coronary artery disease group (stenosis more than 50%) and non coronary heart disease group (50%). According to whether fQRS wave was found, fQRS group and non fQRS group were divided into 40 points, 40-80 points and 80 points three groups according to the score of the coronary artery. The stenosis degree of the coronary artery and its branches in three main branches was divided into 50%, 50-74 A total of 486 cases of coronary artery disease (coronary lesions) were clearly diagnosed as coronary lesions. [results] 486 patients were diagnosed as coronary artery disease (coronary lesions). Degree above 50%) 394 cases, non coronary heart disease (50%) 92 cases, according to whether fQRS divided into group fQRS 240 cases (220 cases of coronary heart disease) and no fQRS group 246 cases (coronary heart disease 174),.1 coronary artery disease patients with coronary artery disease fQRS group and no fQRS group, two group Gensini score (40, 40-80 groups, 80 group) accounted for the proportion of cases respectively For 74 people (33.6%) Vs 93 (53.4%), 88 (40%) Vs 51 (29.3%), 58 (26.4%) Vs 30 (17.2%), the difference was statistically significant between the different groups. The non coronary heart disease group (stenosis 50%), the coronary heart disease patients were divided into 33.6% groups according to the Gensini score. (63.3%), 58 people (65.9%), except between the 40-80 and 80 groups, the difference was not statistically significant, the difference was statistically significant between the two groups of adjacent two groups. The number of lead in the group fQRS of the patients with coronary heart disease was Z=-3.204, P=0.001, and the 40-80 group was compared with the 80 packet fQRS in the group fQRS of coronary heart disease, and the number of the lead of the 40-80 group was compared with the 80 group fQRS. 6, P=0.000.2 coronary artery stenosis degree fQRS group and no fQRS group (50%, 50-74%, 75-99%, complete occlusion) accounted for 20 (8.3%) Vs 72 (29.3%), 34 (14.2%) Vs 47 (19.1%), 107 (44.6%) Vs 96 (44.6%) Vs 96 people (19.1%), Vs group, P0.05, total occlusion group P0.05, the difference was statistically significant. According to the degree of stenosis, the difference was not statistically significant. According to the degree of stenosis, there were 50% groups, group 50-74%, group 75-99%, and complete occlusion group, and the detection rates of fQRS were 20 (21.7%), 34 (42%), 107 (52.7%), 79 (71.8%), except 50-74% group and 75-99% group, and the difference was not statistically significant, the difference between the remaining P0.05 groups between adjacent two groups was different. The difference between the 2 groups was not statistically significant. There was statistical significance. The stenosis degree of fQRS group in coronary heart disease patients was compared with 75-99%, and the number of fQRS leads to Z=-2.414, P=0.000; 75-99% was compared with the complete occlusion group, and the number of fQRS appeared in Z=--3.970, and the proportion of the fQRS group and the anterior descending branch in the fQRS group and the non fQRS group, the circumflex branch and the right crown lesion were 197, respectively. Cases (89.5%) Vs 158 cases (90.8%), 137 cases (62.3%) Vs 105 cases (60.3%), 166 cases (75.5%) Vs 118 cases (67.8%), all the comparison groups were all P0.05, the difference was not statistically significant. [conclusion]1. electrocardiogram fQRS has a certain predictive value for coronary artery disease range and stenosis in patients with coronary heart disease, which can help clinical patients with coronary heart disease quickly. Preliminary evaluation and selection of the most suitable treatment for.2. patients with coronary heart disease, the number of fQRS leads to the degree and scope of coronary artery disease also has a certain predictive value,.3.fQRS wave has certain diagnostic value for coronary lesion, but it is not clear that the detection rate of the related vascular.4.fQRS in adult male is not clear because of its corresponding lead. The sex is high.

【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R541.4;R540.41

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