急性心肌梗死患者静脉溶栓对QTd的影响及其临床意义

【目的】探讨急性心肌梗死（AMI）患者静脉溶栓对QT离散度（QTd）的影响，并评价其与近期恶性室性心律失常的相关性。【方法】将158例AMI静脉溶栓的患者分为再通组和未再通组，比较溶栓前、溶栓后24h的QTd变化，同时观察两组患者溶栓治疗后一周内恶性室性心律失常的发生情况，分析其与QTd的相关性。【结果】静脉溶栓再通组QTd明显减少（P〈0．01），未再通组无明显变化（P〉0．05）；再通组恶性室性心律失常发生率明显低于未再通组（12．7％比32．1％，P〈0．01）。AMI伴恶性室性心律失常者的QTd明显大于无恶性室性心律失常者（P〈0．01）。【结论】成功的静脉溶栓能显著减少AMI患者的QTd，降低恶性室性心律失常的发生率；QTd对判断静脉溶栓疗效、评价AMI近期预后具有一定的临床参考价值。

Clinical Significance and the Effect of QT Dispersion in Acute Myocardial Infarction Experienced Intravenous Thrombolysis

Objective] To explore the influence of intravenous thrombolysis in patients with acute myocardial infarction （AMI） on QT dispersion （QTd）, and assess the relationship of QTd and malignant ventricular arrhythmia at an early stage after AMI. Methods] A total of 158 patients with AMI were divided into recanalization group and non -recanalization group based on the effect of intravenous thrombolysis. The variation in QTd between before and 24 hours after intravenous thrombolysis and the incidence of malignant ventricular arrhythmia in one week following intravenous thrombolysis were compared between two groups, and the relationship between the variation in QTd and the risk of malignant ventricular arrhythmia was evaluated. Results] QTd was lower （ P 〈0.01） after intravenous thrombolysis in recanalization group, but QTd was not changed significantly （ P 〉0.05） in non recanalization group. The incidence of malignant ventrieular arrhythmia was significantly lower （12. 7% vs 32.1%, P 〈0.01 ） in recanalization group than that in non-reca nalization group. QTd was bigger （ P 〈0. 01） in patients with malignant ventricular arrhythmia than that in patients without malignant ventricular arrhythmia. Conclusion]QTd can be decreased significantly in patients with AMI if they experience successful intravenous thrombolysis, so that the incidence of malignant ventricular arrhythmia could be decreased, too. QTd may serve as a valuable predictor to judge the effect of intravenous thrombolysis and evaluate the prognosis after AMI.