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目的:探讨急性ST段抬高型心肌梗死(ASTEMI)患者心电图异常J波对短期内发生心律失常的预测价值。方法:回顾性分析2007年1月至2012年12月在我院行急诊冠脉介入治疗(PCI)的204例ASTEMI患者的心电图及心电监护记录资料。应用单因素、多因素Logistic回归分析心肌梗死1周内发生心律失常的影响因素。结果:204例患者中,心电图检获异常J波者82例(40.2%),多数分布于心电图下壁导联。多因素Logistic回归分析显示,异常J波(OR=14.05,P=0.01,95%CI 1.70~116.40)、J波分布于≥2个部位(OR=13.38,P=0.01,95%CI 1.53~38.68)及J波振幅≥0.2mV(OR=4.28,P=0.02,95%CI 1.82~16.72)是持续性室速/室颤发生的独立预测因子,但不能作为包括非持续性室速、持续性室速、室颤在内的所有室性心律失常发生的预测因子(P均>0.05),亦不能预测房性心律失常的发生(P均>0.05)。多因素Logistic回归分析显示,糖尿病是ASTEMI患者发生≥30s的房速及房颤的独立预测因子(OR=2.29,P=0.047,95%CI 1.01~5.18)。结论:心电图异常J波是ASTEMI后短期内发生持续性室速/室颤的独立预测因素。
Objective: To investigate the predictive value of abnormal J wave of electrocardiogram in patients with acute ST-segment elevation myocardial infarction (ASTEMI) for arrhythmia occurring in short term. Methods: A retrospective analysis of ECG and ECG records of 204 ASTEMI patients undergoing emergency PCI during our hospital from January 2007 to December 2012 was performed. Univariate and multivariate Logistic regression analysis was used to analyze the influencing factors of arrhythmia within one week after myocardial infarction. Results: Among the 204 patients, 82 cases (40.2%) of abnormal wave J were detected by electrocardiogram, most of them were located in the inferior leads of ECG. Multivariate Logistic regression analysis showed that J wave was more than or equal to 2 sites (OR = 13.38, P = 0.01, 95% CI 1.53 ~ 38.68, P = 0.01, 95% CI 1.70-116.40) ) And J-wave amplitudes ≥0.2 mV (OR = 4.28, P = 0.02, 95% CI 1.82 to 16.72) were independent predictors of persistent VT / VF but not as a function of non-sustained ventricular tachycardia, Ventricular tachycardia, ventricular tachycardia, ventricular tachycardia, ventricular tachycardia and ventricular arrhythmias (P> 0.05). Multivariate Logistic regression analysis showed that diabetes mellitus was an independent predictor of atrial fibrillation and atrial fibrillation in patients with ASTEMI ≥30s (OR = 2.29, P = 0.047, 95% CI 1.01-5.18). Conclusion: The abnormal J wave of electrocardiogram is an independent predictor of sustained VT / VF in short term after ASTEMI.