杨建业　余雄丽　凡建平　邓鹏

[摘要] 目的 研究平面QRS-T夾角与急性心肌梗死（AMI）患者术后并发心律失常的关系。 方法 选取2014年3月～2017年12月华中科技大学同济医学院附属同济医院接受经皮冠状动脉介入术（PCI）治疗的AMI患者160例为研究对象。将所有患者根据术后QRS-T夹角的不同分为A组（42例）与B组（118例）。A组患者术后平面QRS-T夹角>90°，B组患者术后平面QRS-T夹角≤90°。分别比较两组一般资料、术后各项资料以及术后用药情况，并作Logistic回归分析。 结果 A组高龄、高血压患者占比均明显高于B组，差异有统计学意义（P < 0.05）。A组术后心律失常发生率、左室射血分数<45%人数占比以及QTc间期均明显高于B组，差异有统计学意义（P < 0.05）。A组术后使用β受体阻滞剂患者占比明显低于B组，差异有统计学意义（P < 0.05）。单因素Logistic回归分析提示：年龄、高血压、左室射血分数<45%、QTc间期、应用β受体阻滞剂、平面QRS-T夹角>90°均是AMI患者术后并发心律失常的影响因素（P < 0.05）。经多因素Logistic回归分析可得：应用β受体阻滞剂是AMI患者术后并发心律失常的保护因素，而平面QRS-T夹角>90°是AMI患者术后并发心律失常的危险因素（P < 0.05）。 结论 平面QRS-T夹角>90°是AMI患者术后并发心律失常的独立危险因素，在临床工作中应重点关注术后平面QRS-T夹角>90°以及未应用β受体阻滞剂患者，预防心律失常的发生。

[关键词] 急性心肌梗死；心律失常；平面QRS-T夹角；危险因素

[中图分类号] R54 [文献标识码] A [文章编号] 1673-7210（2018）09（b）-0030-04

[Abstract] Objective To study the relationship between plane QRS-T angle and postoperative arrhythmia in patients with acute myocardial infarction （AMI）. Methods A total of 160 patients diagnosed with AMI treated with percutaneous coronary intervention （PCI） from March 2014 to December 2017 in Tongji Hospital Affiliated to Tongji Medical College， Huazhong University of Science and Technology were selected. All the patients were divided into group A （42 cases） and group B （118 cases） according to the postoperative plane QRS-T angle. Postoperative plane QRS-T angle in group A was >90°， which in group B was ≤90°. The general data， postoperative data and postoperative medication status were compared between the two groups， and Logistic regression analysis was performed. Results The proportion of aged and hypertension in group A were significantly higher than group B， the differences were statistically significant （P < 0.05）. The incidence of postoperative arrhythmia， the proportion of left ventricular ejection fraction <45% and QTc interphase in group A were significantly higher than group B， the differences were statistically significant （P < 0.05）. The β blockers using proportion in group A was significantly lower than that in group B， and the difference was statistically significant （P < 0.05）. Single factor Logistic regression analysis promoted： age， hypertension and left ventricular ejection fraction<45%， QTc interphase， application of β blockers， plane QRS-t angle>90° were the factors affected postoperative arrhythmia in patients with AMI （P < 0.05）. The multi-factor Logistic regression analysis promoted： the use of β blockers was a protective factor for postoperative arrhythmia in AMI patients， and the plane QRS-T angle>90° was the independent risk factor for postoperative arrhythmia in AMI patients （P < 0.05）. Conclusion Plane QRS-T angle>90° is the independent risk factor for postoperative arrhythmia in AMI patients， and doctors should focus on QRS-T angle>90° and patients without the application of β blockers in clinical work， to prevent the occurrence of arrhythmia.

[Key words] Acute myocardial infarction； Arrhythmias； Plane QRS-T angle； Risk factors

急性心肌梗死（AMI）属于临床上较为常见的心血管疾病之一，目前临床上主要采用经皮冠状动脉介入术（PCI）治疗，效果明显[1]。其中心律失常屬于AMI患者早期常见的并发症之一，具有较高的发病率，一旦发生将会对患者的生命健康安全造成极大威胁[2]。因此，对于AMI患者术后心律失常的发生进行早期准确的预测，有利于干预方案的制订，从而达到改善患者预后的目的。随着相关研究的逐渐深入，越来越多的学者发现，平面QRS-T夹角不仅能反映心室除极和复极的关系，同时对心律失常可能具有较高的预测价值[3]。目前……