常用无创心电指标预测恶性室性心律失常的临床研究

目的本研究拟通过分析QT间期、心率变异性、心室晚电位与恶性室性心律失常的相关性,探讨常用无创心电指标对恶性室性心律失常的预测价值。方法选取2007年1月至2012年10月在我院心内科病房检测到恶性心律失常的142患者为观察组,选取同期无恶性心律失常的160例心内科住院患者为对照组,全部患者均在入院后行常规12导联体表心电图、动态心电图及平均信号心电图检查,记录QT间期、心率变异性、心室晚电位,分析此3项无创心电指标与恶性室性心律失常的相关性。结果观察组QT间期、心率变异性及心室晚电位均明显高于对照组,两组相比较P均<0.05,差别有统计学意义;采用Logistic回归法计算出各危险因素的OR值,三者OR均>1,其大小依次为心室晚电位、心率变异性、QT间期。结论 QT间期、心率变异性、心室晚电位均是预测恶性心律失常的有效指标,其中以心室晚电位危险性最高,三者联合检测可提高预测恶性心律失常的有效性。     

急性心肌梗死患者QT变异度和QT变异系数

目的:描述急性心肌梗死(AMI)患者心室复极变异度和变异系数。方法:55例AMI患者和60例正常人接受24 hHolter检测,人工编辑QRS-T波群模板,计算机辅助测定24 h和每小时平均QT间期、标准差。计算24 h、白天、夜间QT间期标准差(即QT变异度,QTV)和QT变异系数(QTCV)。结果:组内比较,正常对照组QTV昼夜呈动态变化,有明显差别(P<0.01),AMI组则不显著;组间比较,两组QTV均在7:00～8:00达最大值,但AMI组明显低于正常组,且AMI组24 h和白天QT变异度也显著低于正常对照组(P<0.01),夜间则无明显差异。结论:AMI患者全天和白天QTV和QTCV显著降低,失去正常人昼夜规律,反映了AMI患者心室复极电活动紊乱,可能与交感神经受损有关。QTV和QTCV可能是AMI患者自主神经受损和电生理紊乱的新指标,且QTCV较QTV更有统计学价值。     

扩张性心肌病QT离散度与室性心律失常及猝死的关系

目的 :探讨扩张性心肌病 (DCM)QT离散度 (QTd)、校正过的QT离散度 (QTcd)与室性心律失常及猝死的关系。方法 :对 10 7例DCM患者体表心电图QT间期测量值及 89例健康体检者测量值进行对比分析 ,并分析其与室性心律失常及猝死发生率间的关系。结果 :DCM组的QTd、QTcd明显高于正常对照组 (P <0 0 1) ,QTd≥ 6 0ms者室性心律失常发生率高于QTd <6 0ms者 (P <0 0 1) ,猝死者QTd、QTcd明显高于正常对照组 (P <0 0 1)。结论 :QTd可能是DCM室性心律失常及猝死监测的重要指标。     

冠状动脉腔内成形术后QT离散度变化

QT间期离散度(QTd)是指不同导联QT间期的差异,可反映心室各部位复极的不一致性。QTd增大可见于急性心肌梗死等多种缺血性心脏病,它与恶性室性心律失常发生有关。有研究表明,成功地开通梗死相关血管可降低患者QTd。本文通过观察QTd的变化以探讨冠状动脉腔内成形术(PT-CA)对冠心病患者心肌复极化的影响。1 对象和方法1.1 对象 作者在北大人民医院进修期间收集该院2002年成功施行PTCA住院患者60例,男42例,女18例,年龄57～75岁,平均65±8岁。急性     

心肌梗死患者QT间期变异性和心率变异的分析

目的　探讨 QT间期变异性 (QTV)、QT间期变异系数 (QTCV )在心肌梗死患者中的意义 ,两指标与心率变异性 (HRV)是否有联系以及联系的强度。方法　对 5 4例诊断明确的心肌梗死患者和 5 0名正常人进行 2 4 h动态心电图的 QTV、QTCV、HRV的对比分析。结果　心肌梗死患者和对照组的 QTV (2 0± 6比 2 9± 9,P=0 .0 0 0 1)和 QTCV(0 .0 5 4± 0 .0 16比 0 .0 76± 0 .0 2 4 ,P=0 .0 0 0 1)差异有显著性 ;各组中 HRV和 QTV有弱相关性 (P<0 .0 5 ) ,HRV和 QTCV无相关 (P>0 .0 5 )。结论　心肌梗死患者 QTV、QTCV减低 ,HRV的变化几乎不影响两者的变化 ,QTV和 QTCV可能成为预测心律失常的新指标     

小剂量索他洛尔和美托洛尔治疗肥厚型心肌病伴恶性室性心律失常的疗效观察

目的观察小剂量索他洛尔和美托洛尔(倍他乐克)联合治疗肥厚型心肌病伴恶性室性心律失常的疗效。方法对36例肥厚型心肌病伴恶性心律失常的患者,给予索他洛尔和美托洛尔口服治疗,并对心率、QT间期最大值、QT间期最小值和QT间期离散度进行治疗前后的测量。结果治疗后,总有效率为75%,心率由基础的(84.5±5.4)次/min降至(66.5±8.3)次/min(P<0.01),QT间期最大值由治疗前的(411±34)ms延长到治疗后的(415±41)ms(P>0.05),QT间期最小值由治疗前(313±32)ms延长至(353±42)ms(P<0.01),QT间期离散度由治疗前(95±31)ms缩小至(63±20)ms(P<0.01)。无心功能恶化,不良反应轻微。结论本方法疗效确切、方便、安全,无明显致心律失常作用,值得临床推广应用。     

美托洛尔剂型差异对不稳定型心绞痛患者QT间期离散度及心率变异性的影响

目的 探讨美托洛尔剂型差异对不稳定型心绞痛患者QT间期离散度及心率变异性的影响.方法 将本院2014年3月至2016年3月收治的88例不稳定型心绞痛患者随机分为平片组和缓释片组,每组44例.在常规冠心病治疗的基础上,平片组患者给予口服酒石酸美托洛尔片治疗,缓释片组患者给予口服琥珀酸美托洛尔缓释片治疗.两组患者均以1个月为一疗程,连续治疗3个疗程,比较两组治疗前后QT间期离散度及心率变异性的差异.结果 治疗30 d后,缓释片组患者SDNN、SDANN、RMSSD、PNN50分别为(127.26±31.81) ms、(120.92±34.04) ms、(52.33±10.56) ms、(19.21±3.30)％,明显高于平片组的(111.64±27.29) ms、(107.17±28.54)ms、(42.15±7.42) ms、(13.78±4.36)％,差异均有统计学意义(均P＜ 0.05);缓释片组患者QTd、QTcd分别为(38.46±11.02) ms、(34.43±10.17) ms,明显低于平片组的(53.55±15.36)ms、(43.07±12.23) ms,差异均有统计学意义(均P＜0.05);治疗3个月后,缓释片组临床控制率和总有效率分别为36.36％、90.91％,明显高于平片组的13.64％、72.73％,差异均有统计学意义(均P＜ 0.05).结论 美托洛尔缓释片治疗不稳定型心绞痛的临床疗效及对QT间期离散度及心率变异性的影响均明显优于美托洛尔平片,更有利于改善患者的预后.     

炙甘草汤对糖尿病性心肌病心律失常发生率和心率变异性及QT离散度的影响

目的研究炙甘草汤对糖尿病性心肌病心律失常发生率和心率变异性及QT离散度的影响。方法收集60例糖尿病心肌病患者作为研究对象,患者随机分为对照组(n=28)和治疗组(n=32)。2组采用控制血糖、降血压、降血脂、抗心力衰竭、心绞痛等基础治疗。对照组给予普罗帕酮口服治疗,治疗量为100~200 mg/次,3~4次/d,7 d为1个疗程,连续服用4周。治疗组在以上药物基础上加用炙甘草汤水煎取汁400 ml,分早晚2次温服,1剂/d,2周为1疗程。2组患者采用动态心电图观察治疗前后各种心律失常的发生率、心率变异性(HRV):全部窦性心搏RR间期的标准差(SDNN)、RR间期平均值标准差(SDANN)、相邻RR间期差值的均方根(RMSSD)、相邻NN之差>50 ms的个数占总窦性心搏个数的百分比(PNN50)及QT离散度(QTd)。结果 2组治疗后传导阻滞、室性心律失常、房性心律失常、窦性心律失常、交界性心律失常的发生率与治疗前比较,差异有统计学意义(P<0.05),治疗组治疗后传导阻滞、室性心律失常、房性心律失常、窦性心律失常、交界性心律失常的发生率与对照组比较,差异有统计学意义(P<0.05)。对照组治疗后SDNN、SDANN、QTd水平与治疗前比较差异有统计学意义(P<0.05),治疗组治疗后SDNN、SDANN、RMSSD、RNN50、QTd水平与治疗前比较差异有统计学意义(P<0.05)。治疗组治疗后SDNN、SDANN、RMSSD、RNN50、QTd水平与对照组比较差异有统计学意义(P<0.05)。结论炙甘草汤可以减少糖尿病心肌病患者心律失常的发生,对心脏自主神经功能有明显改善作用。     

心电图的Q-T间期和Q-T间期离散度

心电图上的Q-T间期是指ORS波群起点至T波终点这段时间,反映心室除极开始到心室复极结束的时间间隔,代表心室除极和复极的时间总和。Q-T间期等于心室有效不应期和相对不应期的总和,代表心室的总不应期,Q-T间期变化与心室复极过程的改变有关,并且受很多因素如心率、性别、电解质、药物特别是抗心律失常药物和某些疾病的影响,也可以说凡能改变动作电位2相和3相时程的因素均能引起Q-T间期改变。在影响Q-T间期的众多因素中,以心率对其影响最大,当心率增快时QT间期缩短,而心率减慢时则Q-T间期延长。为了得到可靠的Q-T间期值,临床心电图学提出心率     

糖尿病心肌病患者30例窦性心率震荡现象分析

目的研究窦性心率震荡(HRT)在糖尿病心肌病(DC)患者中的变化,以及与心率变异性时阈指标(SDNN)、左室射血分数(LVEF)、左室舒张末期内径(LVEDD)的关系。方法选择DC患者30例,正常健康对照20名,根据24h动态心电图(Holter)记录资料,计算HRT的两个参数震荡初始(TO)和震荡斜率(TS),比较两组差别,并计算TO、TS与SDNN、LEVF、LEVDD之间的相关性。结果DC组TO值显著高于对照组[(3±5)%vs(-6±4)%,P<0.01];DC组TS值显著低于对照组[(6±6)/RR间期,P<0.01]。TO与SDNN、LVEF、LVEDD之间明显相关。结论DC患者室性早搏后的HRT现象变钝。     

Circadian changes in the QT variability index in the beagle dog

1. QT variability is a non-invasive marker of cardiac repolarization lability and a higher QT variability is associated with sudden death. No data exist as to the circadian fluctuations in QT variability and the QT variability index (QTvi) in the canine. The purpose of the present investigation was to explore QT interval variability over 24 h in the healthy dog. 2. Continuous lead II electrocardiogram and blood pressure data were collected for 24 h from three beagles instrumented with radiotelemetry devices. The mean heart rate (HR), detrended HR variance, mean QT interval and detrended QT variance were calculated from the instantaneous HR and QT time series of 1024 points (256 s), as described previously, and a normalized QTvi was derived. 3. The dog has a diurnal pattern of QTvi similar to healthy humans. Both dogs and humans exhibit a significantly higher QTvi during active waking hours, with more negative values during deep sleep. 4. These findings suggest QTvi may serve as an additional non-invasive tool to assess ventricular repolarization lability in dogs in relation to any conditions or drugs that are known to be associated with increased cardiac mortality.     

环常绿黄杨碱D对室性期前收缩及QT间期离散度的影响

目的 :观察环常绿黄杨碱D对室性期前收缩及QT间期离散度 (QTd)的影响。方法 :85例室性期前收缩病人 ,分成环常绿黄杨碱D组 (治疗组 )4 5例 ,对照组 4 0例。 2组均行一般治疗和病因治疗 ,其中治疗组加环常绿黄杨碱D 2mg ,po ,tid ,疗程 2wk。结果 :对照组治疗后 2 4h室性期前收缩减少 ,差值为 (- 5 10± 382 )次· 2 4h- 1(P <0 .0 1) ,QTmin延长 (P <0 .0 5 ) ,其余各项QT指标无明显变化。治疗组加环常绿黄杨碱D后 ,QT延长 ,QTmax和QTmin延长、QTd 缩小、HR减慢 (P <0 .0 1或P <0 .0 5 )、2 4h室性期前收缩明显减少 ,差值为(- 2 130± 4 41)次·2 4h- 1(P <0 .0 1) ,2组比较差异有非常显著意义 (均P <0 .0 1) ,无明显副作用。结论 :环常绿黄杨碱D是一种安全、有效的抗室性期前收缩药物     

扩张型心肌病患者心率震荡的变化规律

目的探讨扩张型心肌病(DCM)患者心率震荡(HRT)的变化规律及预测价值。方法42例DCM患者和50名正常对照均接受动态心电图(Holter)、超声心动图等检查,记录临床资料,分别计算HRT的两个参数震荡初始(TO)和震荡斜率(TS),并进行3￣42个月的随访。结果DCM患者TO明显高于对照组,TS明显低于对照组(P<0.05);重度DCM患者TS明显低于轻度DCM患者(P<0.05);TO与左室射血分数(LVEF)明显相关,TS与心率变异性(HRV)、LVEF明显相关。结论DCM患者HRT现象明显减弱,HRT可作为判断DCM预后的指标。     

胺碘酮转复心房纤颤时对QT离散度影响

目的 :评价胺碘酮在治疗心房纤颤中对心肌复极的影响。方法 :测量了 4 8例用胺碘酮转复和维持治疗房颤患者的QT间期与QT离散度 ,并与 2 1例阵发房颤和 4 3例健康对照组比较。结果 :阵发房颤动组与健康对照组QT间期和QT离散度无差异 (QT :4 0 5± 4 4vs3 97 3 0ms .QTc :4 48± 4 7vs4 2 4± 2 6ms ,QTD 2 9± 1 7vs2 7± 1 6ms ,QTcD :2 8±1 9vs2 6± 1 8ms ,P >0 .0 5) ,但与前两对照组比 ,胺碘酮明显延长QT期间并使QTD增大 (QT :4 65± 53vs4 0 5± 4 4or3 97± 3 0ms ,QTc :4 49± 54vs4 48± 4 7or 4 2 4± 2 6ms ,QTD :4 7± 2 0vs2 9± 1 9or 2 7± 1 6ms ,QTcD :4 9± 2 1vs2 8± 1 9or 2 6± 1 8ms ,P <0 .0 1 )。结论 :胺碘酮不仅延长心肌复极 ,且使复极离散。     

Inhalation of diluted diesel engine emission impacts heart rate variability and arrhythmia occurrence in a rat model of chronic ischemic heart failure

Both increase in cardiac arrhythmia incidence and decrease in heart rate variability (HRV) have been described following human and experimental animal exposures to air pollutants. However, the potential causal relationship between these two factors remains unclear. Incidence of ventricular arrhythmia and HRV were evaluated during and after a 3 h period of Diesel engine exhaust exposure in ten healthy and ten chronic ischemic heart failure (CHF, 3 months after coronary ligation) Wistar rats using implantable ECG telemetry. Air pollutants were delivered to specifically designed whole body individual exposure chambers at particulate matter concentrations similar to those measured inside cabins of cars inserted in congested urban traffic. Recordings were obtained from unrestraint and unsedated vigil rats. Immediate decrease in RMSSD was observed in both healthy (6.64 ± 2.62 vs. 4.89 ± 1.67 ms, P < 0.05) and CHF rats (8.01 ± 0.89 vs. 6.6 ± 1.37 ms, P < 0.05) following exposure. An immediate 200–500% increase in ventricular premature beats was observed in CHF rats only. Whereas HRV progressively returned to baseline values within 2.5 h after exposure start, the proarrhythmic effect persisted as late as 5 h after exposure termination in CHF rats. Persistence of ventricular proarrhythmic effects after HRV normalization suggests that HRV reduction is not the mechanism of cardiac arrhythmias in this model. Our methodological approach, closely reflecting the real clinical situations, appeared to be a unique tool to provide further insight into the pathophysiological mechanisms of traffic related airborne pollution health impact.     

高血压左室肥厚QT间期离散度与室性心律失常及心率变异性之间关系的探讨

目的 探讨高血压左室肥厚（ＬＶＨ）和非左室肥大（ＮＬＶＨ）ＱＴ间期离散度（ＱＴｃｄ）与室性心律失常及心率变异性（ＨＲＶ）之间的关系。关系 对８６例高血压患者分为有或无左室肥厚两组进行ＱＴｃｄ与２４ｈ动态心电图及ＨＲＶ测定。结果 发现高血压ＬＶＨ组的ＱＴｃｄ延长和室性心律失常明显高于高血压ＮＬＶＨ组（Ｐ〈０．０１）,而高血压ＬＨＶ组的ＨＲＶ明显低于高血压ＮＬＶＨ组（Ｐ〈０．０１）。结论 高血压ＬＶＨ     

Increased QT interval variability index in acute alcohol withdrawal

OBJECTIVE: Acute alcohol withdrawal is associated with increased cardiovascular mortality, most likely due to cardiac arrhythmias. As the QT interval reflects the most critical phase for the generation of reentry and thus for arrhythmia, we examined QT variability in patients suffering from acute alcohol withdrawal. METHODS: High resolution electrocardiographic recordings were performed in 18 male unmedicated patients suffering from acute alcohol withdrawal, 18 matched controls and 15 abstained alcoholics. From these, parameters of beat-to-beat heart rate and QT variability such as approximate entropy and QT variability index (QTvi) were calculated. Measures were correlated with the severity of withdrawal symptoms and with serum electrolyte concentrations. RESULTS: Heart rate and QTvi were significantly increased in acute alcohol withdrawal. Abstained alcoholics did not significantly differ from controls. While QTvi correlated with the severity of alcohol withdrawal symptoms, the mean QT interval duration showed an inverse relationship with serum potassium concentrations. CONCLUSION: Our data indicate increased QT variability and thus increased repolarization lability in acute alcohol withdrawal. This might add to the elevated risk for serious cardiac arrhythmias. In part, these changes might be related to increased cardiac sympathetic activity or low potassium, thus suggesting the latter as possible targets for adjuvant pharmacological therapy during withdrawal.     

No Untoward Effect of Long‐Term Ketoconazole Administration on Electrocardiographic QT Interval in Patients with Cushing's Disease

Ketoconazole is listed among drugs that prolong QT interval and may increase the risk of torsade de pointes, a severe ventricular arrhythmia. This compound has recently been approved for treatment of Cushing's syndrome, a severe endocrine disorder. These patients harbour several risk factors for prolonged QT interval, for example hypokalaemia and left ventricular hypertrophy, but no study has evaluated whether administration of ketoconazole affects their QT interval. The aim of this study was to assess the QT interval in patients with Cushing's disease during long‐term administration of ketoconazole. Electrocardiograms from 15 patients with Cushing's disease (12 women, 3 men, age: 37.8 ± 2.66 years) on ketoconazole treatment (100 mg–800 mg qd) for 1 month to 12 years were reviewed retrospectively. QT interval was measured and corrected for heart rate (QTc). Measurements before and during ketoconazole treatment were compared and any abnormal QTc value recorded. Concurrent medical therapies were also documented. On average, QTc was superimposable before and during ketoconazole treatment (393.2 ± 7.17 versus 403.3 ± 6.05 msec. in women; 424.3 ± 23.54 versus 398.0 ± 14.93 msec. in men, N.S.). QTc normalized on ketoconazole in one man with prolonged QTc prior to treatment; no abnormal QTc was observed in any other patient during the entire observation period, even during concurrent treatment with other QT‐prolonging drugs. In conclusion, long‐term ketoconazole administration does not appear to be associated with significant prolongation of QT interval in patients with Cushing's disease. ECG monitoring can follow recommendations drawn for other low‐risk QT‐prolonging drugs with attention to specific risk factors, for example hypokalaemia and drug interactions.     

参仙升脉口服液联合尼非卡兰治疗室性心律失常的临床研究

目的 探讨参仙升脉口服液联合盐酸尼非卡兰治疗室性心律失常的临床疗效.方法 回顾性分析2018年12月—2020年12月在平顶山市第一人民医院进行治疗的52例室性心律失常患者为研究对象,根据用药差别将所有患者分为治疗组和对照组,每组各26例.对照组给予注射用盐酸尼非卡兰,0.3 mg/kg,溶入0.9％氯化钠注射液20 ...