急性心肌梗塞病人QT、JT离散度与室性心律失常及心功能的关系的临床观察

QT离散度(QT dispersion，QTd)、JT离散度(JTd)是指体表心电图各导联QT间期、JT间期的变异程度。有研究表明。QTd和JTd的增加对室性心律失常、心力衰竭及心源性猝死的预测有一定的临床意义。本文观察了64例急性心肌梗塞患者的QTd和JTd与室性心律失常和心功能不全的关系。     

急性心肌梗塞41例QT间期离散度的临床分析

QT间期离散度(QTd)是指心电图上各导联时限变异的程度,其大小可反映心室复极的不一致。急性心肌梗塞(AMI)早期室性心律失常的发生率较高,是引起心源性猝死的主要原因。本文测定了41例急性心肌梗塞(AMI)患者心电图QT间期离散度(QTd)及JT间期离散度(JTd),现将结果报告如下:     

急性心肌梗死QT离散度增加与室性心律失常的关系

目的 探讨急性心肌梗死QT离散度增加与室性心律失常的关系及其意义。方法 回顾性单盲法分析116例急性心肌梗死（AMI）QT离散度（QTd)、心率校正QT离散度（QTCd)和JT离散度（JTd)。结果 AMI室性心律失常组47例与无室性心律失常组69例QTd,QTcd,JTd比较差异均有显著性（P＜0．01）,并且QTd,QTcd,JTd≥60ms时室性心律失常的发生率为55．9％,53．1％,52．3％,≥100ms者100％发生室性心律失常。结论 在临床上QTd,QTcd或JTd≥60ms即预示恶性心律失常的发生。     

高血压左室肥厚与QT离散度及JT离散度的关系

QT离散度(QTd)是指体表心电图不同导联之间最长QT与最短QT间期的差值。JT离散度(JTd)是指体表心电图不同导联之间最长JT与最短JT间期的差值。它们均能反映心室肌复极化的不均一性和电不稳定性，并可作为心脏病患者恶性心律失常的危险指标，亦可作为心肌缺血的指标。本文研究高血压左室肥厚(LVH)与QTd、JTd的关系。     

急性心肌梗死早期QT间期JT间期离散度与近期严重心律失常的关系

目的 :探讨AMI早期QT间期离散度、JT间期离散度与严重心律失常的关系。方法 :测定 46例AMI患者心梗发生后第 3d的QT间期离散度 (QTd)和JT间期离度 (JTd)。并与30例正常人的对照组比较。结果 :AMI组QTd、JTd、QTcd较对照组显著增大 (P <0 0 1 )。住院期间严重室性心律失常发生组 (1 8例 )的QTd、JTd、QTcd较无严重室性心律失常组 (2 8例 )明显增大 (P <0 0 1 ) ,且发生室颤的 9例患者QTd、JTd、QTcd比无室颤的明显增大 (P <0 0 1 )。结论 :早期测定AMI患者QTd、JTd、QTcd对患者近期严重室性心律失常的发生有预测意义     

急性心肌梗死溶栓治疗前后QT、JT间期离散度与室性心律失常观察

目的:观察急性心肌梗死患者溶栓治疗前后QT、JT间期离散度与室性心律失常发生的临床意义。方法:回顾性分析入选的86例患者,入院后的首次,溶栓治疗后2 h、24 h、1周的同步18导联心电图,由专人测量、计算QT和JT间期离散度,并按Lown室早分级标准≥2级,观察在各个时期的室性心律失常发生例数。结果:在入院后首次ECG与溶栓后各个时期QTd、JTd延长者例数不同,延长程度比较差异无统计学意义(P>0.05);在各个时期QTd、JTd延长患者中,室性心律失常发生率不同,首次为17.91%,溶栓治疗后2 h为20.51%,24 h为24.24%,1周为47.37%,第1组与第2组、第3组比较差异无统计学意义(P>0.05),第1组与第4组比较差异有统计学意义(P<0.05)。结论:在临床工作中对AMI患者连续监测QTd、JTd,动态分析,是发现恶性心律失常的危险信号之一,并可获得疾病转归信息,此方法简便易行且为非创伤性,在基层可广泛应用。     

扩张型心肌病患者QTd与室性心律失常关系

为了寻求扩张型心肌病 (DCM)发生严重心律失常的预测指标 ,采用体表心电图 ,对 42例 DCM病人入院时无心律失常者不同导联 QT间期、JT间期进行测定 ,同时设立对照组 ,分别计算 QT间期离散度 (QTd、JT间期离散度 (JTd)。离散度。经 30日观察 ,结果得到 QTd、JTd大者易发生室性心律失常 ,而 QTd、JTd小者和对照组无室性心律失常发生 P<0 .0 0 1。结论 :QTd和 JTd可作为 DCM预测室性心律失常的重要指标。     

急性心肌梗塞后QT、JT间期离散度变化与室性心律失常的关系

急性心肌梗塞(AMI)后心律失常是常见而严重的并发症之一。QT间期离散度(QTd)已被视为预测AMI后发生恶性室性心律失常及猝死的指标之一。QTd反映心室肌复极不同步性和电不稳定性程度。JT间期离散度(JTd)消除了心室肌除极时限的影响能更准确地反映心室肌复极情况。本文对AMI后患者QTd、JTd变化与发生室性心律失常进行了观察分析。     

急性心肌梗死QT间期及JT离散度变化的临床意义

目的：探讨急性心肌梗死（AMI）早期QT间期离散度（QTd）与JT间期离散度（JTd）的变化及其临床意义。方法：测定61例AMI患者及70例正常对照组的QTd、JTd及校正后的QT与JT间期离散度（QTcd、JTcd）。结果：（1）AMI组QTd、JTd较对照组显著增大（均P＜0．001）。（2）不同梗死部位的QTd、JTd无明显差异（P＞0．05）。（3）合并严重室性心律失常者明显大于无室性心律失常者（P＜0．001）,（4）心源性死亡组显著大于未死亡者。（5）EF≤45％组大于EF＞45％组（P＜0．01）。结论：AMI早期QTd、JTd显著增大,与严重室性心律失常的发生、心源性死亡及心功能状况密切相关,提示QTd的测定对预测心脏事件和猝死有重要参考价值。     

急性心肌梗塞早期QT,JT离散度临床分析

观察114例急性心肌梗塞（AMI）患者第三日心电图QT离散度（QTd）、JT离散度（JTd），并以94例正常人作对照．结果显示：AMI组QTd、JTd较正常组明显增大（P＜0．01），并且随着QTd、JTd的增大，死亡率呈显著相关的上升趋势，同时发现前壁心梗较其他各壁心梗的QTd、JTd死亡率高（P＜0．05）。本文提示QTd、JTd是评价AMI患者早期预后的敏感指标。     

健康人T波峰末间期及其离散度调查

目的 观察健康人T波峰末间期(TpTe)及其离散度和心率校正的TpTe(TpTe/√RR)及其离散度,分析TpTe和心率的关系,为临床进行TpTe 的研究提供适用的正常对照值.方法 选取1012名健康体检者,其12导联心电图T波在Ⅱ、Ⅴ3、Ⅴ4和Ⅴ5导联直立,终末部清晰可辨.分别测量标Ⅱ、V3、V4和V5导联QT间期、QTP间期(自QRS波群起点至T波最高点的时间),计算TpTe(TpTe = QT间期 - QTP间期)和TpTe 离散度,TpTe /√RR及其离散度.相关分析探究TpTe与心率的关系.结果 ① TpTe 各导联总均值为(84±10)ms,95%可信区间为64.87~103.71 ms.标Ⅱ导联TpTe 最短为(82±10)ms,Ⅴ4、Ⅴ5导联TpTe 相等且最长为(85±10)ms,标Ⅱ导联与Ⅴ3导联及Ⅴ4、Ⅴ5导联比较差异均有统计学意义(q=7.98,P＜0.01;q=8.07,P＜ 0.01),而Ⅴ3导联与Ⅴ4、V5导联比较差异无统计学意义(q=0.09,P＞0.05).TpTe离散度为(4±7)ms,95%可信区间为10.49~17.92 ms.TpTe及其离散度各导联性别和年龄组间差异均无统计学意义(P＞0.05).②TpTe/√RR各导联总均值为(92±12)ms,95%可信区间为69.07~114.47 ms.标Ⅱ导联TpTe/√RR最短为(89±11)ms,Ⅴ4、Ⅴ5导联TpTe/√RR相等且最长为(93±11)ms,标Ⅱ导联与Ⅴ3导联及Ⅴ4、Ⅴ5导联比较差异均有统计学意义(q=7.70,P＜0.01;q=7.58,P＜0.01),而Ⅴ3导联与Ⅴ4、Ⅴ5导联比较差异无统计学意义(q=0.124,P＞0.05).TpTe/√RR离散度为(4±8)ms,95%可信区间为11.95~19.64 ms.TpTe/√RR及其离散度各导联性别和年龄组间差异均无统计学意义(P＞0.05).③ 随着心率从60~100次/min渐次增快,QT间期逐渐缩短,二者呈显著负相关(r=-0.599,P＜0.01),而TpTe却无明显变化,与心率无相关性(标Ⅱ导联:r=-0.102,P＞0.05;Ⅴ3导联:r=-0.077,P＞0.05; Ⅴ4 =Ⅴ5导联:r=-0.084,P＞0.05).结论①得到了健康人TpTe及其离散度和TpTe/√RR及其离散度的参考值;②在正常心率范围,TpTe不受心率快慢的影响,不必进行心率校正. Abstract： Objective To investigate on the Tpeak-Tend interval (TpTe), the TpTe dispersion, the heart rate-corrected Tpeak-Tend interval (TpTe/√R-R), the TpTe/√R-R dispersion, and the relationship between the heart rates and the TpTe in healthy people. Methods One thousand and twelve healthy individals with T wave being positive and T wave end point being clear in limb leads Ⅱ and in chest leads Ⅴ3, Ⅴ4 and Ⅴ5 were included. 12 leads electrocardiogram was taken. QT interval and QTP interval (the distance from QRS complexs starting point to T wave end point) was measured in limb leads Ⅱ and in chest leads Ⅴ3, Ⅴ4 and Ⅴ5. TpTe (TpTe = QT interval - QTP interval ), TpTe dispersion, TpTe/√R-R and the TpTe/√R-R dispersion was calculated. The linear correlation was used to analyse (84±10)ms,95% confidence interval was 64.87-103.71 ms. TpTe was the shortest in lead Ⅱ [(82±10) ms] and the longest in chest leads V4 and Ⅴ5[Ⅴ4=Ⅴ5=(85±10) ms]. TpTe in lead Ⅱ was significantly shorter than those in lead Ⅴ3 and in leads Ⅴ4,V5(q=7.98,P＜0.01;q=8.07,P＜0.01). But TpTe was no significant different between lead Ⅴ3 and leads Ⅴ4,V5(q=0.09,P＞0.05). The TpTe dispersion was (4±7)ms,95% confidence interval was 10.49-17.92 ms. TpTe and the TpTe dispersion TpTe/√RR and the TpTe/√RR dispersion were (92±12) ms (69.07-114.47 ms, 95% confidence interval) and (4±8) ms(11.95-19.64 ms), respectively. TpTe / √RR was the shortest in lead Ⅱ [(89±11)ms] and the longest in chest leads Ⅴ4 and Ⅴ5[Ⅴ4 =Ⅴ5=(93±11) ms]. TpTe/√RR in lead Ⅱ was significantly shorter than those in lead Ⅴ3 and in leads Ⅴ4,V5(q=7.70,P＜0.01;q=7.58,P＜0.01). But TpTe / √RR was not significantly different between lead Ⅴ3 and leads Ⅴ4,V5(q=0.124,P＞0.05). TpTe/√RR and the TpTe/√RR dispersion were not obviously different in both sexes and the QT interval and there were no correlation between the heart rates and TpTe was identified in healthy people with the heart rates from 60 to 100 beats is not necessary that TpTe was corrected by the heart rates, when the heart rates are increasing from 60 to 100 beats per minute.     

QT间期离散度的软件实现方法

本文着重从软件方面介绍了QT间期离散度的实现方法,包括心电信号的采集、显示、数字信号处理、关键点的识别等,并且给出了具体的实现方法、部分关键源程序及程序流程图.     

QT离散度对急性心肌梗塞合并快速室性心律失常的预测

对１５例正常者，１９例急性心梗（ＡＭＩ）４周内无室速，及２０例ＡＭＩ４周内合并室速室颤的ＡＭＩ后２４ｈ左右心电图，进行ＱＴ离散度分析。结果：正常组ＱＴｄ为（１９２±６２）ｍｓ、ＱＴｃｄ为（２３６７±１５９８）ｍｓ，ＡＭＩ无室速者ＱＴｄ（５８４２±２２６）ｍｓ、ＱＴｃｄ（５８５６±２５８７）ｍｓ，ＡＭＩ合并室速室颤者ＱＴｄ（１００５±２６１）ｍｓ、ＱＴｃｄ（１０４２±３２９１）ｍｓ，三组间有显著差异。并以本组资料正常者的ＱＴｃｄｘ＋３ｓ为正常上限，预测ＡＭＩ是否合并室性心律失常的敏感性８０％、特异性７８９％、准确性８０％。     

国人P波离散度的检测及其相关因素分析

目的 :建立健康国人 12导联同步心电图P波离散度平均值 ,并对其相关因素进行分析。方法 :1～ 87(39 4± 17 3)岁健康国人 2 0 78例 ,用广东中山SR 10 0 0A心电综合自动分析仪采集 12导联同步体表心电图数据并录入软盘。结果 :随年龄增长Pmax,Pmin,Pd 及Pcd平均值稍递增 ,Pcmax及Pcmin平均值稍递减 ,但在年龄组间及男女间差别无统计学意义。年龄范围从 1～ 87岁 ,Pmax为 (10 9 85± 7 88)ms ,Pmin为 (80 97± 11 42 )ms,Pcmax为 (12 3 13± 12 0 0 )ms ,Pcmin为 (90 85± 14 40 )ms,Pd 为 (2 8 89± 10 74)ms ,Pcd为 (32 39± 12 10 )ms ;年龄从 1～ 14岁的儿童 ,Pmax为 (10 1 5 4± 9 49)ms,Pmin为 (76 85± 10 19)ms,Pd 为 (2 4 82± 7 5 1)ms,Pcd为 (31 10± 9 89)ms。Pmax出现率在Ⅱ导联占 77 0 4% ,V5导联占14 39% ;Pmin出现率在V1导联占 74 6 9% ,V2 导联占 7 84%。结论 :健康国人各年龄Pmax为 96～ 12 0ms,Pd 为 8～ 5 0ms,Pcd为 10～ 5 6ms,Pd 与心率、年龄及性别无明显相关性     

高血压病左室肥厚与QT离散度分析

目的：探讨高血压病左室肥厚（ＬＶＨ）与ＱＴ离散度（ＱＴｄ）的关系。方法：测量６４例高血压病非ＬＶＨ患者（组Ⅰ）、５８例高血压病ＬＶＨ患者（组Ⅱ）和７６例健康人（组Ⅲ）的ＱＴｄ与较正的ＱＴｄ（ＱＴｃｄ）,并对各组进行比较分析。结果：组ⅡＱＴｄ、ＱＴｃｄ较组Ⅰ、组Ⅱ显著延长（Ｐ均〈０．０１）。结论：高血压病ＬＶＨ的发生及其易出现各种并发症的原因可能与其ＱＴｄ、ＱＴｃｄ的延长有关。     

国人P波离散度的检测及其相关因素分析

OBJECTIVE: To establish mean value of P interval dispersion of 12-lead simultaneous body surface electrocardiogram in healthy Chinese and to analyse its correlative factors. METHODS: 12-lead simultaneous body surface electrocardiogram data were taken from 2078 healthy Chinese aged from 1 to 87 [mean (39.4 +/- 17.3)] years with SR-1000A automated electrocardiography made by Zhongshan, Guangdong province. These data were stored in the floppy disk. RESULTS: Mean value of Pmax, Pmin, Pd and Pcd seemed to be prolonged, and Pcmax, Pcmin to be shortened with increasing of age, but there was no significant difference between age and sex. Mean value of Pmax of the all subjects (1-87 years) was (109.85 +/- 7.88) ms, Pmin (80.97 +/- 11.42) ms, Pcmax (123.13 +/- 12.00) ms, Pcmin (90.85 +/- 14.40) ms, Pd (28.89 +/- 10.74) ms, Pcd (32.39 +/- 12.10) ms; mean values of Pmax, Pmin, Pd and Pcd among the children of 1-14 years were (101.54 +/- 9.49) ms, (76.85 +/- 10.19) ms, (24.82 +/- 7.51) ms and (31.10 +/- 9.89) ms, respectively; 77.04% of Pmax was in II lead and 14.39% in V5 lead, 74.69% of Pmin was in V1 lead and 7.84% in V2 lead. CONCLUSION: The mean value of Pmax is 96-120 ms, Pd 8-50 ms and Pcd 10-56 ms among healthy Chinese. Pd is not significantly related with heart rate, age and sex.     

Changes in the corrected QT interval and corrected QT dispersion during haemodialysis

The link between increased QT dispersion and cardiac death in subjects with diabetes and arterial disease is well recognised. Corrected QT dispersion was studied in subjects with end stage renal failure on haemodialysis. Thirty one stable, chronic subjects on haemodialysis had 12-lead electrocardiograms (ECGs) taken before and after a single haemodialysis session. The QT interval was measured manually in each and the corrected QT and corrected QT dispersion calculated. Serum concentrations of potassium, calcium, and magnesium were measured at the same time as ECG acquisition. Corrected QT dispersion increased from a mean (SEM) 90.6 (5.8) to 117.7 (10.2) ms (p=0.002). Serum potassium and magnesium decreased from 5.0 (0.14) to 3.5 (0.09) mmol/l and 0.95 (0.04) to 0.89 (0.09) mmol/l respectively, while serum calcium increased from 2.56 (0.04) to 2.77 (0.04) mmol/l. Intradialytic weight fell by a mean of 2.1 kg. There was no significant correlation between the change in QTc dispersion and the changes in measured serum anions or the subjects' weight during dialysis. Corrected QT dispersion was higher in subjects on haemodialysis than previously suggested normal values, and was significantly increased by haemodialysis. This reflects increased inhomogeneous ventricular repolarisation, which may lead to an increased risk of arrhythmias and sudden death. Studies looking at QT dispersion in subjects on dialysis should standardise the timing of ECG recordings taken with respect to dialysis.     

高血压病左室肥厚与QTc离散度关系的研究

目的 探讨高血压病病左室肥厚（ＬＶＨ）与非在室肥厚（ＮＬＶＨ）患者ＱＴｃｄ的关系及临床意义。方法 用分层抽样法测定１０３例原发性高血压病患者住院首次１２导联心电图ＱＴｃ离散度（ＱＴｃｄ）其中合并ＬＶＨ患者５７例，合并ＮＬＶＨ患者４６例，并与２０例健康人作对照，结果 ＱＴｃｄＬＶＨ组分别与ＮＬＶＨ组，对照组比较均有非常显著性差异（Ｐ〈０．０１）ＮＬＶＨ组与对照组比较无显著性差异（Ｐ〉０．０５）。结论     

急性心肌梗死住院死亡病人QT离散度分析

目的探讨QT离散度(QTd)与急性心肌梗死(AMI)死亡和预后的关系.方法AMI住院死亡病人35例为研究对象,同期住院存活病人随机挑选50例为对照组,测量两组病人的QTd,并进行统计学分析.结果死亡组QTd:78.50±38.15(ms),QTcd:70.50±35.10(ms)对照组QTd:65.00±22.40(ms),QTcd:53.50±26.32(ms),两组比较有显著差异(P＜0.05),结论QTd对预测AMI死亡危险性和估计预后有一定的临床意义.     

急性心肌梗死Q-T离散度昼夜变异性分析

目的探讨急性心肌梗死患者Q-T离散度(Q-Td)昼夜变异性及其与预后的关系。方法对50例急性心肌梗死患者在发病<72h做12导联同步动态心电图检查,50例无器质性心脏病患者作对照组,测量每小时的Q-Td,将8:00～20:00定义为日间,0:00～次日5:00为夜间,按心率校正公式计算出日间和夜间的Q-Tcd。结果急性心肌梗死(观察组)患者Q-Tcd呈日间(昼)高,夜间(夜)低,昼夜相比差异有统计学意义(P<0.05)。对照组昼夜相比差异无统计学意义(P>0.05)。昼Q-Tcd观察组亦大于对照组(P<0.05),夜Q-Tcd观察组大于对照组(P<0.05)。结论急性心肌梗死患者Q-Td存在昼夜变异性,日间Q-Td高于夜间,值得临床医师重视。