本文選題：早期復(fù)極　切入點：室性心律失常　出處：《安徽醫(yī)科大學》2017年碩士論文

【摘要】：目的本文主要探討早期復(fù)極(Early Repolarization ER)對急性ST段抬高型心肌梗死(acute ST-segment elevation myocardial infarction STEMI)患者住院期間發(fā)生室性心律失常(Ventricular arrhythmia VA)和遠期預(yù)后的影響。方法回顧性分析298例STEMI患者臨床基線資料和心電圖資料,根據(jù)有無早期復(fù)極分為ER組和無ER組,其中ER組56例,無ER組242例,比較兩組間住院期間基線資料、VA的發(fā)生率和隨訪期間全因死亡率的差異;用單因素、多因素logistics回歸分析患者住院期間發(fā)生VA的危險因素。根據(jù)ER形態(tài)分為切跡型ER組和頓挫型ER組,根據(jù)ER所在導聯(lián)分為下壁導聯(lián)組、非下壁導聯(lián)組,根據(jù)J波后ST形態(tài)分為水平型/下斜型ST段組、上斜型ST段組,分別與無ER組比較住院期間VA發(fā)生率和隨訪期間全因死亡率的差異。結(jié)果1、ER組和無ER組間基線資料比較差異均無統(tǒng)計學意義;ER組住院期間VA發(fā)生率和隨訪期間全因死亡率均高于無ER組,差異有統(tǒng)計學意義(P0.001,P=0.01);多因素Logistic回歸分析ER和LVEF50%是STEMI患者住院期間發(fā)生VA的獨立預(yù)測因素。2、切跡型ER組、頓挫型ER組、無ER組住院期間VA發(fā)生率及隨訪期間死亡率差異均有統(tǒng)計學差異(p0.001,P=0.02),兩兩比較,切跡型ER組與無ER組住院期間VA發(fā)生率及隨訪期間死亡率差異均有統(tǒng)計學差異(p0.001,p=0.004),其余各組差異無統(tǒng)計學意義。3、下壁導聯(lián)ER組、非下壁導聯(lián)ER組、無ER組住院期間VA發(fā)生率和隨訪期間全因死亡率差異均有統(tǒng)計學意義(P0.001,P=0.038),兩兩比較,僅下壁導聯(lián)ER與無ER組住院期間VA發(fā)生率差異有統(tǒng)計學意義(P0.001),其余各組差異均無統(tǒng)計學意義。4、水平型/下斜型ST段組、上斜型ST段組、無ER組住院期間VA發(fā)生率和隨訪期間全因死亡率差異有統(tǒng)計學意義(P0.001,P=0.003),兩兩比較,水平型/下斜型ST段組與無ER組住院期間VA發(fā)生率和隨訪期間全因死亡率差異有統(tǒng)計學意義(P0.001,P=0.01),其余組間差異無統(tǒng)計學意義。結(jié)論在STEMI患者中ER特別是切跡型ER、ER伴水平型/下斜型ST段增加住院期間VA發(fā)生率和隨訪期間全因死亡率;下壁導聯(lián)ER增加住院期間VA的發(fā)生率;ER和LVEF50%是STEMI患者住院期間發(fā)生VA的獨立危險因素。
[Abstract]:Objective to investigate the effects of early Repolarization on the incidence of ventricular arrhythmias during hospitalization and long-term prognosis in patients with acute ST-segment elevation myocardial infarction STEMII (acute ST-segment elevation myocardial infarction STEMI). Methods A retrospective analysis of 298 patients with STEMI was made. Clinical baseline data and ECG data, According to whether there was early repolarization or not, ER group was divided into ER group (56 cases) and no ER group (242 cases). Multivariate logistics regression analysis was used to analyze the risk factors of VA during hospitalization. According to the morphology of ER, the patients were divided into two groups: the notch ER group and the cadaveric ER group, the lower wall lead group and the non-inferior wall lead group according to the ER lead. According to the shape of St after J wave, they were divided into horizontal / inferior St segment group and upper oblique St segment group. Results (1) there was no significant difference in baseline data between ER group and ER group. The mortality rate was higher in ER group than in ER group. Multivariate Logistic regression analysis showed that ER and LVEF 50% were independent predictors of VA in STEMI patients during hospitalization. There were significant differences in the incidence of VA during hospitalization and mortality during follow-up in ER free group. There were significant differences in the incidence of VA during hospitalization and mortality during follow-up between the ER group and the non-ER group. There was no significant difference between the other groups. The ER group with inferior wall lead and ER group with non-inferior wall lead had no significant difference in the other groups, and there was no significant difference between the two groups in the lower wall lead ER group and the non-inferior wall lead ER group. The incidence of VA during hospitalization and all-cause mortality during follow-up in ER group were significantly different (P 0.001 P 0.038). The incidence of VA in ER group was significantly different from that in non-ER group (P 0.001), but there was no significant difference in other groups (P < 0.05). The horizontal / inferior St segment group and the upper oblique St segment group had no statistical significance. The incidence of VA during hospitalization and the mortality rate during follow-up were significantly different in ER group (P 0.001 P 0.003). There were significant differences in the incidence of VA during hospitalization and total mortality during follow-up between the horizontal / inferior St segment group and the no ER group. Conclusion there was no significant difference between the other groups. Conclusion ER, especially the notch ERER associated with STEMI, is not significantly different between the other groups. Horizontal / inferior St segment increased the incidence of VA during hospitalization and all-cause mortality during follow-up. Lower wall lead ER increased the incidence of VA during hospitalization. ER and LVEF 50% were independent risk factors for VA in patients with STEMI.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R542.22;R541.7

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本文編號：1653231