经皮冠状动脉腔内成形术对冠心病患者QT离散度的影响

目的通过分析经皮冠状动脉腔内成形术(percutaneoustransluminalcoronaryangioplasty,PTCA)中缺血和再灌注时QT离散度的变化。评价成功的PTCA术对改善QT离散度的临床意义。方法22例冠心病患者行成功的PTCA术治疗,其中男17例,女5例,年龄43～79岁,平均年龄(59.8±9.0)岁,记录PTCA术中及当日同步十二导联动态心电图。分别于术前、首次球囊扩张期间、首次球囊扩张后即刻、术后2h及12h测定QT间期和RR间期,QTd=QTmax-QTmin。结果QTd在首次球囊扩张期间与扩张前比较明显增大(P<0.05),在术后2h及12h均较术前减小(P<0.05),且术后12h与术后2h比较差异有统计学意义(P<0.05);首次球囊扩张后即刻与扩张前比较差异无统计学意义(P>0.05)。结论PTCA球囊扩张期间,由于产生一过性短暂的心肌缺血使QTd增加,而成功的PTCA术可降低冠心病患者的QT离散度,从而可能预防恶性室性心律失常的发生。

Effects of percutaneous transluminal coronary angioplasty on QT dispersion in patients with coronary artery disease

Objective The effects of percutaneous transluminal coronary angioplasty (PTCA ) on QT dispersion (QTd) was evaluated in this study. Methods In this study,22 patients with coronary artery disease underwent successful PTCA. All patients underwent continuous 24 hours monitoring with 12-leads Holter electrocardiography during the day of PTCA. QT and RR intervals were evaluated before, during and in an instant after the first balloon inflation and 2 hours,12 hours after PTCA. QTd= QTmax- QTmin. Results QTd increased during the first balloon inflation compared with that before PTCA (P<0.05). QTd was significantly decreased 2 hours and 24 hours after reperfusion lompared with that before PTCA(P<0.05).And there was significant difference between QTd determined 2 and 12 hours after PTCA(P<0.05).But there was no significant difference between QTd determined before and in an instant after the first balloon inflation (P>0.05). Conclusion Brief episodes of myocardial ischemia during the balloon inflation increased QTd, and QT dispersion was significantly decreased after successful PTCA due to improvement of myocardial ischemia in patients with coronary artery disease. It could decrease the risk of malignant ventricular arrhythmia in patients with coronary disease.