急性心肌梗死48例QT离散度临床意义

目的探讨急性心肌梗死患者溶栓治疗前后QT离散度及校正的QT离散度的变化与恶性心律失常、猝死等心脏事件发生率的相关性。方法将48例急性心肌梗死患者溶栓治疗后根据其是否再通分为两组,分别观察溶栓治疗前后的QT离散度及校正的QT离散度,记录其恶性心律失常、猝死等心脏事件的发生率,并进行统计分析。结果经溶栓治疗后急性心肌梗死患者再通者29例,未通者19例。溶栓再通组于再通后24h内QT离散度迅速降至正常水平,未通组于溶栓治疗后7d方逐渐接近正常水平。溶栓治疗第3d末,再通组QT离散度及校正的QT离散度与治疗前比较差异均有极显著性(t=2.825,2.719,P均<0.01),未通组与治疗前比较均无显著性差异(P>0.05),两组间比较差异均有极显著性(t=2.713,2.941,P均<0.01)。心脏事件发生组QT离散度及校正的QT离散度均极显著高于未发生组(t=2.819,2.691,P均<0.01)。结论QT离散度与心肌梗死后局部心肌复极电活动的不均一性有关;QT离散度及校正的QT离散度越大,恶性心律失常发生率越高。

Clinical significance of QT dispersion in 48 patients with acute myocardial infarction

Objective To explore the dependablity between pre- and post- treatment QT dispersion or corrected QT dispersion changes and the incidence of scuch heart events as malignant arrhythmia and sudden death etc in patients with acute myocardial infarction before and after thrombolysis treatment.Methods 48 patients were divided into two groups according to whether recanalization or not, QT dispersion or corrected QT dispersion observed and incidences of scuch heart events as malignant arrhythmia and sudden death recorded and statistically analyzed.Results After thrombolysis treatment, recanalization patients were 29 and non-canalization 19. QT dispersion quickly lowered to normal level within 24 hour after recanalization in the thrombolysis recanalization group and did on the 7th day after thrombolysis treatment in the non-canalization group. At the end of the 3rd day of thrombolysis treatment, there were very significant differences in QT dispersion or corrected QT dispersion compared with pretreatment in the recanalization group(P<0.01), no difference in the non-canalization group(P>0.05) and inter-group comparisons showed very significant difference(P<0.01). QT dispersion or corrected QT dispersion were very significantly higher in the heart event developing group than in the non-developing group(P<0.01).Conclusion QT dispersion is related to heterogeneity of topo-CM repolarization activity following myocardial infarction; the larger is the QT dispersion or corrected QT dispersion, the higher the incidence of malignant arrhythmogenesis.