论文部分内容阅读
目的:探讨心电图QRS波时限延长对老年高血压合并心力衰竭患者心脏不良事件(MACE)的预测价值。方法:选取2015年4月至2018年5月浙江中医药大学附属第三医院及浙江省新华医院收治的老年高血压合并心力衰竭患者226例，患者入院后即刻进行18导联心电图检查，根据QRS波时限进行分组，分为QRS波时限≤120 ms组157例、QRS波时限>120 ms组69例。比较两组患者心功能相关指标、血清N末端脑钠肽前体(NT-proBNP)水平及出院6个月MACE发生率；比较MACE发生患者与未发生MACE患者入院QRS波时限，并采用ROC曲线分析QRS波时限对患者MACE的预测价值。结果:QRS波时限>120 ms组患者左室射血分数(LVEF)(37.49±4.03)%，明显低于QRS波时限≤120 ms组的(44.37±4.92)%(n t＝10.205，n P120 ms组患者左室舒张末期内径(LVEDD)(59.03±3.15)mm、左心室质量指数(LVMI)(147.38±16.28)g/mn 2、血清NT-proBNP(1 097.59±216.49)ng/L，均显著高于QRS波时限≤120 ms组的(56.39±3.97)mm、(138.96±15.36)g/mn 2及(825.36±185.36)ng/L(n t＝4.887、3.726、9.649，均n P120 ms组MACE发生率为53.62%(37/69)，明显高于QRS波时限≤120 ms组的20.38%(32/157)(χn 2＝24.973，n P120 ms was significantly lower than that of the patients with QRS wave duration<120 ms [(44.37±4.92)%](n t=10.205, n P120 ms were significantly higher than those in the patients with QRS wave duration<120 ms [(56.39±3.97)mm, (138.96±15.36)g/mn 2 and (825.36±185.36)ng/L] (n t=4.887, 3.726, 9.649, all n P120 ms (53.62%) was significantly higher than that in the patients with QRS duration<120 ms (20.38%)(χn 2=24.973, n P<0.05). The QRS wave duration was negatively correlated with LVEF(n r=-0.316, n P<0.05), and positively correlated with LVEDD, LVMI and serum NT-proBNP(n r=0.362, 0.405, 0.378, n P<0.05). The time limit of QRS wave in the patients with MACE[(137.64±21.05)ms] was significantly longer than that in the patients without MACE [(112.65±19.85)ms](n t=8.556, n P<0.05). The predictive value of QRS wave duration of ROC curve for MACE was 0.852.n Conclusion:QRS wave duration is closely related to cardiac function and serum NT-proBNP level in elderly patients with hypertension and heart failure, and prolonged QRS wave duration has good predictive value for adverse cardiac events, which can be used as a clinical monitoring index.