急诊PCI前后QT离散度、T波峰-末间期和缺血性J波的变化及意义

目的探讨急诊直接经皮冠状动脉介入治疗（PCI）对急性心肌梗死（AMI）患者QT离散度（QTd）、T波峰末间期（Tp-Te）和缺血性J波的作用及临床意义。方法选择滁州市第一人民医院收治的AMI患者155例，分为急诊PCI组和单纯药物治疗组，分别测量两组治疗前后24h内的QTd、Tp-Te以及各导联J波的时限和波幅，分析两组治疗前后QTd、Tp-Te以及缺血性J波的发生率和等级的变化。结果单纯药物治疗组治疗前后QTd、Tp-Te以及缺血性J波发生率的比较差异无统计学意义（P〉0．05）；急诊PCI组术后QTd和rrp-Te显著减小，差异具有统计学意义（P=0．000），术前术后缺血性J波发生率的比较差异无统计学意义（x2=1．25，P=0．263）；急诊PCI术前小J波、大J波及巨大J波分别为90、31、4个，术后三者分别为92、13、2个，差异具有统计学意义（x2=7．07，P〈0．05）。结论急诊PCI对AMI患者缺血性J波的发生率可能无影响，但对QTd、Tp-Te的大小和缺血性J波的等级的变化有较好的影响。

Changes of QT dispersion,Tpeak-Tend interval and ischemic J wave and the clinical significances before and post primary percutaneous coronary intervention

Objective To observe the effects of primary percutaneous coronary intervention(PCI) on QT dispersion(QTd),Tpeak-Tend interval(Tp-Te) and ischmic J wave and to explore the clinical significances in patients with acute myocardial infarction(AMI).Methods We retrospectively analyzed 155 patients with AMI who were treated in the First People’s Hosipital of Chuzhou.All of the patients were divided into two groups,the primary PCI group and simple drug group.The 12-lead ECGs were recorded within 24 hours before and after treatment,measuring the QTd,Tp-Te,ischmic J wave time course and wave amplitude.The changes of QTd,Tp-Te and ischmic J wave were analyzed.Results QTd,Tp-Te and the incidences of ischemic J waves had no statistical significance before and after the treatment in the simple drug group(P>0.05);QTd and Tp-Te were remarkably decreased after primary PCI.Difference had statistical significance(P=0.000).The incidences of ischemic J waves had no statistical significance pre and post primary PCI(χ2=1.25,P=0.263).The numbers of small,large and enormous J waves were 90,31 and 4 repectively before primary PCI and 92,13 and 2 after the procedure(χ2=7.067,P<0.05).Conclusion Primary PCI may have no effect on the incidences of ischemic J waves for people with AMI.However,the numerical value of QTd and Tp-Te and the level of ischemic J waves were significantly decreased after primary PCI,suggesting that primary PCI could improve QTd,Tp-Te and ischemic J waves in patients with AMI.