【摘要】：目的心血管疾病是我國乃至世界范圍內(nèi)目前致死率和致殘率最高的疾病之一,心肌梗死作為心血管疾病急重癥的一種,嚴重的威脅著人類的健康。早期診斷和合理干預對于提高患者的生存率至關重要。碎裂QRS波是一種新的心電圖學指標,現(xiàn)階段認為檢測出碎裂QRS波,可能預示著心�；颊叩念A后不不佳。但由于臨床研究的特殊性,無法系統(tǒng)的梳理f QRS波與急性心梗的關系。本實驗通過建立大鼠心肌梗死模型,探討心肌梗死后早期檢測出f QRS的價值。方法健康雄性SD大鼠100只,體重200~300 g,在剔除過術前已經(jīng)存在的f QRS波的大鼠,隨機分為假手術組(S組)、模型組(M組)。采用冠狀動脈左前降支結扎的方法構建大鼠心梗模型,假手術組只穿線不結扎。根據(jù)術后6小時心電圖檢測結果,將S組和M組大鼠細分為4個亞組:假手術未檢出f QRS波(S0組),假手術檢出QRS波(Sf組);模型組未檢出f QRS波(M0組),模型組檢出QRS波(Mf組)。分別檢測每組大鼠心肌標志物指標肌酸激酶同工酶CK-MB、乳酸脫氫酶LDH,炎癥指標C-反應蛋白(CRP),病理學指標。并觀察術后2月大鼠存活情況,檢測術后2月存活大鼠心電圖檢出f QRS波情況,心肌血管緊張素II受體1(AT1R)表達情況。結果術前心電圖篩查時,未手術健康大鼠有2只檢測到了fQRS波的存在。術后6小時心電圖情況,假手術組有11.54%比例出現(xiàn)f QRS波。相比假手術組,更容易在心梗模型組術后6小時心電圖中檢出f QRS波,檢出比為43.33%。模型組大鼠各項心肌標志物指標均高于比假手術組,病理學檢查也提示模型組大鼠出現(xiàn)了大面積的梗死。亞組之間互相對比,檢出f QRS波并未使心肌標志物水平增高、病理學結果也無特別差距。模型組大鼠術后炎癥指標要明顯高于假手術組,而檢出Mf組相比未檢出M0組,炎癥指標上升的更多。心梗組大鼠術后2月的存活率明顯低于假手術組大鼠,而Mf組大鼠的存活率要明顯低于M0組。術后2個月心電圖顯示,f QRS波檢出明顯增多。S0組檢出率為上升至36.84%,M0組檢出率上升至81.25%,而Mf組大鼠f QRS波始終存在。術后2個月對存活的大鼠心肌切片免疫組化染色,心梗組大鼠術后AT1R的表達明顯增多,其中相比M0組Mf組表達了更多的AT1R結論大鼠心梗后早期檢查f QRS波并不反應心梗的嚴重程度,但f QRS波的檢出極大的影響著心梗大鼠的存活率
[Abstract]:Objective Cardiovascular disease is one of the diseases with the highest mortality and disability rate in China and the world at present. Myocardial infarction (MI) is a serious threat to human health as one of the acute and severe cardiovascular diseases. Early diagnosis and reasonable intervention are essential to improve survival rate. Fragmentation QRS wave is a new electrocardiographic index. At present, it is considered that the detection of broken QRS wave may predict the poor prognosis of patients with myocardial infarction. However, due to the particularity of clinical research, the relationship between f QRS wave and acute myocardial infarction can not be systematically combed. The purpose of this study was to investigate the value of early detection of f QRS in rats with myocardial infarction. Methods 100 healthy male Sprague-Dawley rats, weighing 200 ~ 300g, were randomly divided into sham operation group (S group) and model group (M group). Rat myocardial infarction model was established by left anterior descending coronary artery ligation. According to the results of electrocardiogram examination at 6 hours after operation, the rats in group S and group M were subdivided into four subgroups: sham operation did not detect fQRS wave (S0 group), sham operation detected QRS wave (SF group), model group did not detect fQRS wave (M0 group), model group detected QRS wave (MF group). Myocardial markers CK-MBs, LDHs, C-reactive protein (CRP) and pathological indexes were measured in each group. The survival of rats was observed 2 months after operation, and the expression of angiotensin II receptor 1 (AT1R) in myocardium was detected by electrocardiogram (ECG). Results during electrocardiogram screening before operation, fQRS waves were detected in 2 unoperated healthy rats. 6 hours after operation, there were 11.54% f QRS waves in sham operation group. Compared with sham operation group, f QRS was more easily detected in ECG of myocardial infarction model group 6 hours after operation, and the detection ratio was 43.33. The indexes of myocardial markers in the model group were higher than those in the sham operation group, and the pathological examination also showed that there was a large area of infarction in the model group. Compared with other subgroups, the f QRS wave did not increase the level of myocardial markers, and there was no special difference in pathological results. The inflammatory indexes in the model group were significantly higher than those in the sham operation group, and the inflammatory indexes in the MF group were higher than those in the non-M0 group. The survival rate of myocardial infarction group was significantly lower than that of sham operation group, while that of MF group was significantly lower than that of M0 group. Two months after operation, electrocardiogram showed that the detection rate of fQRS wave in S0 group increased to 36.84%, and that in M0 group increased to 81.25%, while in MF group, the detection rate of fQRS wave was always present. Two months after operation, the expression of AT1R was significantly increased in the myocardial sections of the surviving rats, and the expression of AT1R was significantly increased in the myocardial infarction group. Conclusion the early examination of f QRS wave after myocardial infarction does not reflect the severity of myocardial infarction, but the detection of f QRS wave significantly affects the survival rate of myocardial infarction rats.
【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

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