Clinical analysis on electrocardiography abnormalities and serum magnesium in patients with acute cerebral hemorrhage

目的 探讨急性脑出血患者心电图的改变和血清镁的变化以及两者之间的关系.方法 138例急性脑出血患者在入院24 h内,常规行12导联心电图检查和血清镁检测.结果 低血镁患者有57例,占全部急性脑出血患者的37%;心动过缓33例,占全部急性脑出血患者的24%;QT间期延长84例,占全部急性脑出血患者的61%.心动过缓与低血镁呈负相关性(r=-0.16,P＜0.05)、QT间期延长和低血镁症的发生呈正相关性(r=0.409,P＜0.05).结论 在急性脑出血患者中,低血镁症与心动过缓和QT间期延长相关,低血镁是急性脑出血患者心电图发生异常的原因之一.     

急性脑出血患者55例心电图及血清镁的临床应用

目的探究急性脑出血患者心电图的变化和血液中血清镁含量的变化,探讨其在脑出血患者病理过程中的潜在作用和两者之间的相互关系。方法选择我院2011年12月-2012年12月收治的急性脑出血患者,共收集到55例患者,在入院的24h内对患者进行常规18导联心电图检查和血液血清镁的含量检测。观察实验结果,心电图、血清酶和急性脑出血是否存在相关性。结果心电图异常情况:55例患者中心电图异常48例,占所有病例的87.27%,心动过缓12例,占所有病例21.82%,其中ST段改变者12例,占所有病例21.82%,QT期延长者31例,占所有病例56.36%;对患者血液血清镁含量检测,低血镁患者18例,占所有病例32.73%。综合分析比较急性脑出血患者的心电图和血清镁含量,心动过缓与低血镁成负相关性,QT间期延长和低血镁症的发生呈正相关性,ST段改变与血清镁不存在相互关系。结论医护人员在对急性脑出血患者进行诊断治疗护理过程中,应着重观察预防和治疗性QT间期延长急性脑出血患者是否出现低血镁的症状,科学有效地对急性脑出血患者进行系统的治疗,有效的降低急性脑出血患者死亡率。     

急性心肌梗死患者QTV及HRV与室性心律失常的相关性

目的分析AMI患者QTV及HRV与室性心律失常的关系。方法比较27例急性心肌梗死患者和30例健康对照组24h动态心电图,分析心肌梗死组和健康对照组心率变异性、QT变异度、QT变异系数等。结果健康对照组QT间期与心率呈直线相关(r=-0.822,P<0.01);急性心肌梗死组QT间期与心率呈直线相关(r=-0.891,P<0.01)。SDNN与心肌梗死严重程度具有相关性(r=-0.511,P<0.01);QTV与心肌梗死严重程度具有相关性(r=-0.613,P<0.01);QTCV与心肌梗死严重程度具有相关性(r=-0.648,P<0.01)。结论急性心肌梗死患者平均心率、QTV、QT间期、SDNN均发生变化,对预测室性心律失常及猝死的发生可能具有重要临床意义。     

重度颅脑外伤急性期患者心电图改变与血清镁的关系

目的探讨重度颅脑外伤急性期患者心电图改变与血清镁的关系,为临床治疗提供参考.方法随机选取中山市东凤人民医院急诊科2013年7月至2014年7月收治的70例重度颅脑外伤患者为研究对象,对其进行心电图和血清镁离子浓度检查,并根据检测结果将所有患者分为低血清镁组和正常血清镁组,对心电图进行分析(包括心率、PR间期、QT间期、QRS波宽度、异常ST段、T波异常和U波的出现),比较2组心电图异常情况.结果70例患者进行血清镁离子测定,低血清镁患者43例,占61.4％,正常血清镁患者27例,比例为38.6％,43例低血清镁组中心电图异常患者31例,占72.1％,正常血清镁组中27例患者有11例心电图异常,占40.7％,2组比例差异具有统计学意义(P＜0.05);血清镁浓度下降组中72.1％的患者出现心电图异常,异常主要表现在Q-T间期延长22例,占71.0％,窦性心动过缓17例,占54.8％,ST-T段下移15例,占48.4％,T波段低平、倒置、双向14例,占45.2％,U波增高5例,占16.1％.结论重度颅脑外伤患者急性期心电图和血清镁浓度水平关系密切,血清镁浓度下降与心电图Q-T期延长呈正相关,患者若Q-T间期延长,要考虑患者是否出现低镁血症,从而进行有效合理治疗,降低患者病死率.     

抗精神病药物致代谢综合征及其组分与心电图QT间期的关系

目的 探讨抗精神病药物致代谢综合征(metabolic syndrome,MS)及其组分与心电图QT间期的关系.方法 对460例服用抗精神病药物的精神分裂症患者进行流行病学调查、身体测量、血生化指标测定及MS诊断,记录标准12导联心电图,用Bazett公式计算校正的QT间期(QTC).采用稳态模式评估法计算胰岛素抵抗指数(HOMA-IR).结果 抗精神病药物致代谢综合征人群心电图QT间期延长者124例,占27.0%,男女心电图QT间期延长检出率分别为21.7%、32.7%,差异有显著性(χ2=7.13,P<0.01).MS、HOMA-IR、中心性肥胖、高血压、高血糖、高TG、低HDL-C的检出率分别为39.3%,38.7%,35.4%,34.1%,31.3%,29.8%,27.0%.心电图QT间期延长与中心性肥胖、高血糖、高TG、胰岛素抵抗(IR)、MS及异常组分聚集有相关关系(χ2=4.95～13.63,P<0.05).结论 心电图QT间期延长与抗精神病药物所致多项代谢异常组分、代谢异常聚集及代谢综合征相关联.     

急性心肌梗死患者急性期体表心电图T波峰末间期与恶性室性心律失常的关系研究

目的探讨急性心肌梗死患者体表心电图T波峰末间期(TpTe)与急性期室性心律失常的关系。方法102例接受直接PCI(pPCI)治疗的急性心肌梗死患者中,共有46例出现室性心动过速(VT)和心室纤颤(VF),作为病例组。其余56例未出现室性心律失常,作为对照组。测量并比较两组pPCI前后12导联心电图的QT、TpTe、QT离散度(QTd)及经心率校正的QT间期(QTc间期)、TpTe(TpTec)。研究室性心律失常与QTc和TpTec各时段上限值的相关性并比较不同梗死部位的QT及TpTe值。结果 pPCI治疗前两组对象的QT间期、QTd间差异无统计学意义(P>0.05),但QTc和TpTec间差异有统计学意义(P<0.05)。经pPCI治疗后第3天,两组间QT和QTd间差异仍无统计学意义,而QTc、TpTe和TpTec间差异有统计学意义(P<0.05)。pPCI治疗后1周TpTe、QTc和TpTec间差异仍有统计学意义(P<0.05)。两组pPCI治疗前后的RR间期无差异(P>0.05)。QTc间期各时段上限值与VT+VF的发生率无相关性(r=0.376,P>0.05)。TpTe及TpTec间期各时段上限值与VT+VF的发生率呈正相关(r=0.677,P<0.05;r=0.698,P<0.05)。结论在急性期出现VT和VF的急性心肌梗死患者与不出现室性心律失常的患者相比,TpTe和TpTec明显延长,但QT和QTd则无明显差异。TpTe可能预示着心肌梗死急性期恶性心律失常。     

长期住院精神分裂症QT间期延长及其相关因素分析

目的调查长期住院精神分裂症患者QT间期延长的发生率,并分析其相关因素。方法收集176例长期住院精神分裂症患者的心电图结果、人口学资料、代谢指标、药物等资料并进行分析。结果长期住院精神分裂症患者QT间期延长的发生率为9.1%。指标异常率:BMI 27.3%、收缩压13.1%、三酰甘油37.5%、总胆固醇15.3%、糖尿病13.1%。QTc间期与总胆固醇呈正相关(r=0.17,P<0.05)。男性、收缩压、总胆固醇、三酰甘油进入QTc间期的回归方程,差异有统计学意义(β分别为-0.16、0.19、0.27、0.23,均P<0.05)。结论长期住院精神分裂症患者存在QT间期延长及代谢相关指标的异常。QT间期延长主要与代谢相关指标异常有关。临床上应特别关注QT间期延长,除考虑药物影响外,还应重视代谢异常的影响。     

慢性心力衰竭患者QT及QT离散度增加与心功能的关系

目的探讨慢性心力衰竭患者校正QT间期(QTc)与QT离散度(QTd)及心功能超声参数相互关系。方法研究了141例左室射血分数(LVEF)<50%的慢性心力衰竭患者QTc与QRS间期、临床指标、心脏超声心动图参数的相关性。结果QTc与年龄(r=0.22,P<0.01)、左室舒张末期直径(r=0.25,P<0.01)、左房直径(r=0.23,P<0.01)、QRS间期(r=0.36,P=0.01)、QTd(r=0.42,P<0.01)呈正相关;与短轴缩短率(r=-0.27,P<0.01)、LVEF(r=-0.34,P<0.01)呈负相关;与二尖瓣E波和A波峰值速度比值、等容舒张时间无相关性(P>0.05)。多元回归分析显示,QTC和QTd、QRS间期、LVEF存在独立相关性。结论QTC与心力衰竭患者预后影响因素相关;QTC与QTd存在独立相关性,可作为慢性心力衰竭预后较好的预测指标。     

急性脑卒中患者心率与QT离散度的变化

目的:分析急性脑卒中患者心率和QT离散度的变化和意义。方法:检测276例急性脑出血、281例急性脑梗死患者和300例正常对照组的标准12导联心电图,观察心率和QT离散度变化。结果:与正常对照组相比,脑出血组和脑梗死组窦性心动过速发生率显著增高,脑出血更显著,而窦性心动过缓的发生率低于对照组;两组平均心室率显著增快,尤以急性脑出血最为显著。脑出血组和脑梗死组QT离散度较对照组显著延长。结论:急性脑卒中患者心率与QT离散度有显著变化。     

QT间期延长与肝移植术后近期心律失常的关系

目的总结和探讨肝移植术前心电图提示QT间期延长与肝移植术后近期各类心律失常的关系。方法回顾性分析北京佑安医院2004年6月～2012年1月500例肝移植患者术前心电图的QT间期与术后近期（术后2周内）各种心律失常的发生率及其诊治资料。结果在500例肝移植患者中有82例（16.4％）发生各类心律失常,其中,病态窦房结综合征（包括持续而显著的窦性心动过缓）35例（7．0％）,阵发性室上性心动过速18例（3．6％）,心房颤动21例（4．2％）,室性心动过速8例（1．6％,包括2例尖端扭转性室性心动过速）;82例心律失常患者中心脏骤停4例（0．8％）,由心律失常引起的死亡2例（0．4％）。根据术前心电图检查结果,将患者分为QT间期延长组共103例,QT间期正常组共397例,其中,QT间期延长组中有28例患者发生心律失常,QT间期正常组中有54例患者发生心律失常,肝移植术后近期心律失常的发生与QT间期延长有明显关系（x^2=11．00,P〈0．01）。结论心律失常是肝移植术后常见的并发症．甚至可导致死亡。术前心电图QT间期延长与肝移植术后近期心律失常的发生有明显关系。因此,对于术前QT间期延长的患者应加强监测和评估,并给予预防性措施,如安置临时心脏起搏器,以防止术中及术后心血管意外的发生。     

21例尖端扭转型室性心动过速的临床分析

目的探讨尖端扭转型室性心动过速的发病机制、诊断及治疗效果.方法对21例Tdp的临床特点及心电图特点进行分析,根据Jackman分类法,将其分为3种类型.Ⅰ型(间歇依赖性长QT间期综合征)15例,多为药物、电解质紊乱(低钾、镁、钙)及各种原因所致心动过缓基础上引起.Ⅱ型儿茶酚胺依赖型(先天性Q-T间期延长综合征)2例.1例为儿茶酚胺依赖型,另1例为长间歇依赖型.Ⅲ型(短联律间期室早所致Tdp)4例,其中2例为冠心病急性心肌梗死,另2例为无器质性心脏病证据者,用异搏定终止发作和预防发作有特效,其余对镁盐治疗有效;同时针对不同病因病情采取综合治疗.结果除1例及外伤未来得及治疗死于室颤外其余患者均于发病后30 min～24 h以内得到控制.结论Tdp多数为Ⅰ型,均有晕厥发作,部分患者发生心室颤动.Ⅲ型中2例无器质性心脏病者异搏定治疗有特效.其余以镁盐及针对病因病情采用综合治疗,均使Tdp得到有效控制.     

调脂治疗对急性心肌梗死QT离散度及室性心律失常的影响

目的 探讨调脂治疗对急性心肌梗死患者QT离散度（QTd）及室性心律失常（VA）的作用。方法 86例急生心肌梗死患者随机分成2组，对照组行常规治疗，治疗组在对照组基础上给予他汀类药物调脂治疗，2周后行24h动态心电图检查，治疗前后作12导联心电图。测量QT间期（QTc）并计算QTd。同时观察治疗后24hVA的发生率。结果 治疗组室性心律失常明显减少，QTd显著减小，血脂无明显变化。结论 急性心肌梗死患者早期使用他汀类药物可减少住院期间室性心律失常的发生，缩短QTd。     

The electrocardiographic changes in acute brain injury patients

Background  Electrocardiographic (ECG) changes occurring during the course of acute brain injury (ABI) have been described frequently, but their significances remain uncertain. The present study was designed to investigate the relation of ECG abnormalities to outcome in the patients with ABI.

Methods  We performed a retrospective, observational study on the ABI patients admitted to the Department of Neurosurgery of the Beijing Tiantan Hospital between December 2005 and December 2007. All the patients accepted 12-lead electrocardiographic examination within 24 hours after injury, then divided into three groups according to the Glasgow coma score (GCS). In-hospital mortality and one-month outcome assessed by the Glasgow outcome score (GOS) were investigated.

Results  Of 335 ABI patients (mean ages 32.4 years), 246 patients (73.4%) had abnormal ECGs. The most common abnormality was ST-T changes (41.5%), followed by sinus tachycardia (23.6%). ECG changes had a significant association with the severity and outcome. Logistic regression analysis showed the presence of ST-T changes (OR 2.587, 95%CI 1.009 to 6.629, P=0.048) and QT dispersion prolongation (OR 4.656, 95%CI 1.956 to 11.082, P=0.001) significantly associated with short outcomes.

Conclusions  ABI can lead to myocardial damage and ECG changes had a significant association with the severity. ST-T changes and QT dispersion prolongation were the independent prognosis factors for the negative outcome of ABI patients.

     

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.     

甲减中甲状腺激素水平与心脏电生理活动的相关性研究

目的探讨甲状腺功能减退症甲状腺激素水平与心脏电生理活动的相关性。方法对100例原发性甲减患者（甲减组）和100例正常人（正常对照组）进行常规十二导联ECG检查,分别检测心率（HR）、PR间期（PR）、QRS波时限（QRS）、QT间期（QT）、ST段压低幅度、T波等,同时用化学发光法测定血清总三碘甲状腺原氨酸（TT3）、总甲状腺素（TT4）和促甲状腺激素（TSH）水平,对心电图指标和血清TH水平行相关性分析。结果甲减组心电图异常率高于正常对照组（x2=34.557,P=0.000）。TSH、T3及病程判断心电图异常的能力较好,差异有统计学意义（P〈0.05）。甲减组心率显著低于正常对照组,PR间期、QRS时间、QT间期较正常对照组显著延长（P〈0.01）,心率与TSH、T3、T4呈显著正相关。PR间期、QRS时间、QT间期与T3、T4呈显著负相关,与TSH呈显著正相关。ST段压低、T波异常（倒置、低平或双向）与TSH呈显著负相关,与T3、T4呈显著正相关,差异有统计学意义（P〈0.05）。结论原发性甲状腺功能减退症可对患者窦房结起搏产生显著影响,引起心脏自律性改变,并造成明显的心肌缺血损伤。     

Efficacy and tolerability of itopride hydrochloride in patients with non-ulcer dyspepsia

To document the clinical efficacy and tolerability of itopride hydrochloride in patients with non-ulcer dyspepsia an open-label, non-comparative study, was undertaken at the Medical College, Thiruvananthapuram, among patients with endoscopically confirmed diagnosis of non-ulcer dyspepsia or chronic gastritis. Itopride hydrochloride 50 mg (1 tablet) thrice a day for 2 weeks was administered among them. Relief of symptoms at the end of two weeks treatment, assessed as marked/complete, moderate, slight, none or worse; QT interval on ECG; adverse events; haemogram; serum chemistry for hepatic and renal functions. None had QT prolongation on ECG. At the end of 2 weeks' treatment, moderate to complete relief of symptoms was reported by 22 patients (73%), whereas 5 (17%) reproted slight improvement, and 3 (10%) reported no improvement. Clinical tolerability was excellent in 28 patients (93%) and good in 2 (7%). None of the patients had any prolongation of QT on ECG, nor did any patient show any abnormality in haemogram or serum chemistry during the treatment.     

The effect of arsenic trioxide on QT interval prolongation during APL therapy

Objective To investigate the cardiac effect of QT interval prolongation in the treatment of acute promyelocytic leukemia (APL) with arsenic trioxide (As2O3), and the relationship between QT and serum arsenic concentration.Methods Blood serum arsenic concentrations of thirty APL patients were determined at 2 hours, 4 hours, 8 hours, and 24 hours after As2O3 injection using atomic fluorophotometry. Cardiac functions were measured simultaneously using a 12-lead body-surface electrocardiogram (ECG). Q-T intervals were manually measured, and then corrected using Bazett’s formula (QTc). QT dispersion (QTd) was also calculated. In order to assess the effects of arsenic on the symptoms of anemia, twenty-four anemia patients were divided into two groups on the basis hemoglobin concentration: Group1 (Hb≥90 g/L), and Group 2 (60 g/L≤Hb＜90 g/L). QTc and QTd of these patients were also manually measured.Results All QT intervals of APL patients treated with As2O3 injection were prolonged ［32.2 ms (27, 41 ms); P&lt; 0.05］, but the changes of QTd were not prominent ［3 ms (－8, 7 ms), P&gt; 0.05］. There was a delay of 2 hours in maximum QTc following peaks in serum arsenic concentration. Changes in QTc and QTd of the two anemic groups were not prominent.Conclusions As2O3 can prolong QTc intervals in APL patients, but the effects are delayed compared to peak serum arsenic concentrations. As2O3 has no prolongation effect on QTd. Mild and moderate anemia do not effect QTc and QTd.     

QT离散度在急性肺栓塞中的临床意义

目的: 探讨急性肺栓塞患者的QT离散度变化及临床意义。方法: 收集2011年5月至2012年4月中南大学湘雅医院急性肺栓塞患者42例,根据入院时情况分为高危组(16例)和非高危组(26例),以年龄与性别匹配的同时期健康体检者30例为正常对照组。肺栓塞患者入院24 h内及治疗后分别行同步十二导联心电图检查,手工测量QT间期,并计算出QT离散度(QT dispersion,QTd)及心率校正的QT离散度(heart rate-corrected QT dispersion,QTcd)。短期随访患者住院期间生存情况,根据生存情况分为生存组(31例)及死亡组(11例)。结果: QTd及QTcd在高危组[(70.2±34.0),(88.1±43.3) ms]及非高危组[(49.3±21.8),(59.1±26.2) ms]均显著大于正常对照组[(33.2±12.4),(36.7±14.2) ms](P<0.05);高危组又显著大于非高危组(P<0.05)。前后两次心电图间隔为(5.6±2.5) d,治疗后生存组QTd及QTcd [(41.0±16.4),(47.4±18.0) ms]较入院时[(54.0±33.0),(67.2±40.5) ms]显著减小(P<0.05),但仍大于正常组(P<0.05),死亡组治疗前后QTd及QTcd差异无统计学意义(P>0.05)。多元logistic回归分析表明:入院时高危、存在右室功能障碍、治疗后QTcd仍大于正常范围是住院期间死亡的主要影响因素。结论: 急性肺栓塞患者QTd及QTcd增大;合并右室功能障碍、入院时危险度高及治疗后QTcd大于正常范围者住院期间短期预后不良。