延迟PCI治疗STEMI患者Tp－ec、Tp－e／QT及心率震荡值的变化及预测价值

目的：探讨急性ST段抬高型心肌梗死（STEMI）患者延迟经皮冠状动脉介入（PCI）治疗前后Tp－ec、Tp－e／QT比值及心率震荡（ HRT）的变化及其对冠状动脉病变支数的预测价值。方法应用心电图及24 h动态心电图记录60例STEMI患者延迟PCI术前及术后心电信息，测算PCI前后Tp－ec、Tpe－／QT比值及HRT震荡起始（ TO）和震荡斜率（TS）]值，进行对比分析。并通过冠脉造影结果，观察冠状动脉单支病变24例及多支病变36例上述各心电指标的差异。另选取同期56例健康者为对照组。观察入院时STEMI组与对照组上述各心电指标的差异。结果（1）与对照组比较，STEMI组患者Tp－ec、Tp－e／QT比值均明显延长，TO值明显升高，而TS值明显降低（ P ＜0．05）。（2）延迟PCI术后24 h内Tp－ec及Tp－e／QT比值及HRT较术前即可获得明显改善，术后Tp－ec及Tp－e／QT比值均显著下降， TO值明显降低，而TS值明显升高（ P ＜0．05）。（3）多支病变患者Tp－ec、Tp－e／QT比值均较单支病变者明显延长，TO值明显高于单支病变者，而TS值明显低于单支病变者（ P ＜0．05）。结论急性心肌梗死患者Tp－ec、Tp－eQ／T比值明显延长， HRT明显减弱，而延迟 PCI术能明显改善HRT 、缩短Tp－ec及Tp－e／QT比值，降低恶性心律失常及心源性猝死的发生。 Tp－ec、Tp－e／QT比值及HRT可能成为具有前景的预测STEMI患者冠状动脉病变范围、心肌缺血程度及评估PCI术预后的无创心电指标。

The changes and prediction value of Tp-e,Tp-e/QT ratio and heart rate turbulence in patients with STEMI after delayed PCI

Obj ective To investigate the dynamic changes and prediction value of Tp-e,Tp-e/QT ratio and heart rate turbulence (HRT) in patients with ST-segment elevation myocardial infarction (STEMI) before and after delayed percutaneous coronary intervention ( PCI) .Methods Sixty patients with STEMI were enrolled in the study ( STEMI group ) including 24 cases of single coronary artery lesion (group A) and 36 cases of multiple coronary arteries lesion (group B),moreover,the other 56 healthy subjects were served as control group .The electrocardiography (ECG) and 24h ambulatory electrocardiography were used to detect the electrocardio parameters to measure Tp-ec, Tp-e/QT ratio, HRT turbulence onset ( TO ) and turbulence slope ( TS) ] before and after delayed PCI .The differences of these electrocardio parameters bewteen group A and group B were analyzed and compared according to the examination results by coronary arteriography , furthermore, the differences of these electrocardio parameters mentioned above were compared between STEMI group and control group on admission.Results As compared with those in control group , the Tp-ec, Tp-e/QT ratio in STEMI group were significantly increased,and TO value was obviusly enhanced ,however, TS value was significantly decreased ( P <0.05).The Tp-ec, Tp-e/QT ratio and HRT were obviously improved within 24 hours after PCI,as compared with those before PCI ( P <0.05), moreover, the Tp-ec,Tp-e/QT ratio and TO value were obviously decreased ,however, TS value was significantly increased after PCI ( P <0.05).As compared with those in group A,the Tp-ec,Tp-e/QT ratio were significantly increased in group B , and TO value was obviously higher than that in group A , however , TS value was significantly lower than that in group A ( P<0.05).Conclusion The Tp-ec and Tp-e/QT ratio are significantly increased and HRT is obviously decreased in patients with acute myocardial infarction .However delayed PCI can obviously improve HRT , decrease Tp-ec, Tp-e/QT ratio, and can decrease the incidence rates of malignant arrhythmia ( MAE) and sudden cardiac death .Thus Tp-ec,Tp-e/QT ratio and HRT may be used as important indexes to predict the extent of coronary artery lesion and myocardial ischemia ,and to evaluate the prognosis of patients with STEMI after PCI .