急性下壁心肌梗死相关心律失常的预测因素OA
Predictors for arrhythmia associated with acute inferior wall myocardial infarction
目的 探讨急性下壁心肌梗死患者住院期间发生严重心律失常的预测因素.方法 选取82 例急性下壁心肌梗死患者作为研究对象,根据住院期间是否发生严重心律失常分为心律失常组(n=28)与无心律失常组(n=54).收集两组患者的基线资料、实验室检查结果、心电图及冠状动脉造影指标,包括性别、年龄、糖尿病、高血压、吸烟史、Killip分级、发病至入院时间、入院时收缩压与心率,以及血钾、空腹血糖、低密度脂蛋白胆固醇(LDL-C)、中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、肌钙蛋白I、左心室射血分数(LVEF)、Gensini评分、心电图Q波、ST段抬高幅度、QTc离散度、右冠状动脉优势型供血占比、术前TIMI血流分级等.分析上述指标与心律失常发生的关系.结果 单因素分析显示,两组在性别、年龄、合并糖尿病/高血压、吸烟史、发病至入院时间、入院心率、LDL-C水平、Gensini评分、心电图Q波、ST段抬高幅度及术前TIMI血流分级方面比较,差异均无统计学意义(均P>0.05);而在Killip分级、入院收缩压、血钾、空腹血糖、NLR、肌钙蛋白I、LVEF、QTc离散度及右冠状动脉优势型供血方面,差异均有统计学意义(均P<0.05).多因素Logistic回归分析显示,Killip分级(Ⅲ—Ⅳ级)、NLR≥5.0、QTc离散度≥80 ms及右冠状动脉优势型供血为发生严重心律失常的独立危险因素(均P<0.05),而血钾≥3.8 mmol/L为其独立保护因素(P<0.05).结论 Killip分级高、NLR升高、QTc离散度增大、右冠状动脉优势型供血以及血钾水平较低(<3.8 mmol/L)是急性下壁心肌梗死患者发生严重心律失常的强独立预测因素,有助于早期识别高危患者并指导临床干预.
Objective To investigate the predictors of severe arrhythmia in patients with acute inferior wall myocardial infarction(IWMI)during hospitalization.Methods A total of 82 patients with acute IWMI were enrolled,and divided into an arrhythmia group(n=28)and a non-arrhythmia group(n=54)based on the occurrence of severe arrhythmia during hospitalization.Baseline characteristics,laboratory results,electrocardiogram(ECG),and coronary angiography indexes were collected from both groups.These data included sex,age,diabetes,hypertension,smoking history,Killip classification,time from symptom onset to hospital admission,systolic blood pressure and heart rate on admission,as well as serum potassium,fasting blood glucose(FBG),low-density lipoprotein cholesterol(LDL-C),neutrophil-to-lymphocyte ratio(NLR),troponin I,left ventricular ejection fraction(LVEF),Gensini score,presence of pathological Q waves,ST-segment elevation amplitude,QTc dispersion,right dominant coronary artery supply,and pre-procedural TIMI flow grade.The relationship between the above parameters and the occurrence of arrhythmia was analyzed.Results Univariate analysis revealed no statistically significant differences between the two groups in terms of sex,age,comorbidities(diabetes and hypertension),smoking history,time from symptom onset to hospital admission,heart rate on admission,LDL-C level,Gensini score,pathological Q waves,ST-segment elevation amplitude,or pre-procedural TIMI flow grade(all P>0.05).However,statistically significant differences were observed in Killip classification,systolic blood pressure on admission,serum potassium,FBG,NLR,troponin I,LVEF,QTc dispersion,and right dominant coronary artery supply(all P<0.05).Multivariate Logistic regression analysis identified Killip class(Ⅲ-Ⅳ),NLR≥5.0,QTc dispersion≥80 ms,and right dominant coronary artery supply as independent risk factors for severe arrhythmia(all P<0.05),while serum potassium≥3.8 mmol/L was an independent protective factor(P<0.05).Conclusion High Killip classification,elevated NLR,increased QTc dispersion,right dominant coronary artery supply,and low serum potassium level(<3.8 mmol/L)are strong independent predictors of severe arrhythmia in patients with acute IWMI.These factors facilitate early identification of high-risk patients and guide clinical intervention.
饶霜霜
450006 河南 郑州,河南省直第三人民医院功能科
医药卫生
急性下壁心肌梗死心律失常预测因素QTc离散度血钾
acute inferior wall myocardial infarctionarrhythmiapredictorQTc dispersionserum potassium
《实用心电与临床诊疗》 2026 (1)
45-50,6
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