52例心肌梗塞患者心室晚电位临床分析

５２例心肌梗塞患者心室晚电位临床分析林娜（江苏省盐城市第一人民医院盐城２２４００１）心肌梗塞（心梗）患者用心室晚电位（ＶＬＰ）筛选心源性猝死风险的高危病人日益受到临床重视。为了观察心粳患者ＶＬＰ出现阳性的情况，作者对５２例心梗患者ＬＶＰ临床资料分析如...     

小剂量倍他乐克对老年急性心肌梗死后心室晚电位的影响

研究３６例老年急性心肌梗死（ＡＭＩ）后心室晚电位（ＶＬＰ）阳性患者应用小剂量倍他乐克长期治疗，同时给３２例老年ＡＭＩ患者服消心痛、心痛定对照。结果表明，经小剂量倍他乐克治疗后能使ＶＬＰ转阴（３３／３６），使ＳＡ－ＥＣＧ的ＴＤ－ＱＲＳ、ＬＡＳ较治疗前缩短，ＲＭＳ增加（Ｐ＜０．００１）。提示小剂量倍他乐克长期治疗能使老年ＡＭＩ患者ＶＬＰ转阴，同时要避免大剂量快速用药所致副作用。老年ＡＭＩ患者出现ＶＬＰ阳性如无明显β阻滞剂禁忌症，应首选小剂量倍他乐克长期治疗。     

老年冠心病患者红细胞磷脂与过氧化反应关系的研究

实验观察老年冠心病人红细胞磷脂和血中ＬＰＯ、ＳＯＤ及ＧＳＨ－Ｐｘ含量的变化，并对其相互关系进行了分析。结果表明，各组老年冠心病患者红细胞磷脂中ＬＰＣ、ＳＭ、ＰＳ、ＰＥ和ＳＭ／ＰＣ、ＰＳ／ＰＣ均明显升高，而ＰＣ则显著下降，心肌梗塞组更为明显，标志老年冠心病人细胞老化指数升高，红细胞粘滞性增高，心肌梗塞组ＬＰＯ显著升高，ＳＯＤ、ＧＳＨ－Ｐｘ和ＳＯＤ／ＬＰＯ，ＧＳＨ－Ｐｘ／ＬＰＯ明显降低，说明老年冠心病患者体内氧化与抗氧化平衡失调。逐步回归分析表明，红细胞磷脂各成分与ＬＰＯ和ＳＯＤ有密切关系。     

晚电位与冠心病

对心室晚电位（ＶＬＰ）与冠心病（ＣＡＤ）的关系进行了探讨，并观察了ＶＬＰ的动态演变。结果：ＣＡＤ及其急性心肌梗塞（ＡＭＩ）和陈旧性心肌梗塞（ＯＭＩ）患者ＶＬＰ阳性率分别为４２．０％（１１３／２６９）、５０９％（５４／１０６）和３７．１％（５３／１４３）；在ＡＭＩ合井持续性室性心动过速（ＶＴ）或室颤（ＶＦ）者则高达９１．７％（１１／１２）；发现ＶＬＰ在ＡＭＩ、ＯＭＩ和正常者均存在一定程度的演变。     

心室晚电位、动态心电图和心功能对陈旧性心肌梗塞患者室性心律失常事件的预测价值（摘要）

心室晚电位、动态心电图和心功能对陈旧性心肌梗塞患者室性心律失常事件的预测价值（摘要）山西省心血管病研究所来春林，李运乾，王鞠，许施政，赵素琴１临床资料本文对９１例陈旧性心肌梗塞（ＯＭＩ）患者的预后通过心室晚电位（ＶＬＰ）、动态心电图（Ｈｏｌｔｅｒ）和...     

老年冠心病患者心室晚电位与多普勒超声左室舒张功能测定…

对４８例老年冠心病患者及２０例健康老年人作心室晚电位（ＶＬＰ）和彩色多普勒超声左心室舒张功能测定。结果显示：冠心病组ＶＬＰ阳性率比健康组显著升高（分别为３３．３％及０％，Ｐ＜０．０１），左心室舒张功能较健康组明显降低；ＶＬＰ阳性组与阴性组比较，前者左室舒张功能降低更明显；左室舒张功能参数（Ａ／Ｅ比率）与ＶＬＰ各指标（ＱＲＳ时限、Ｄ４０、Ｖ４０）之间有直线相关关系。     

经皮冠状动脉腔内成形术对冠心病患者心室晚电位的 …

为观察经皮冠状动脉内成形术（ＰＴＣＡ）对心室晚电位（ＶＬＰ）的影响，对３８例冠心病患者ＰＴＣＡ前，后的信号平均心电图（ＳＡ－ＥＣＧ）进行定位，定量分析和随访观察，时域分析发现，３例ＶＬＰ阳性中的１例ＰＴＣＡ术后ＶＬＰ消失，有５．７％（２／３５）ＶＬＰ阴性患者后ＶＬＰ转为阳性；频谱时间标测发现，４例ＶＬＰ阳性中的２例术后ＶＬＰ消失，有１１．８％（４／３４）ＶＬＰ阴性患者术后ＶＬＰ转为阳性；全组患者中     

老年冠心病患者心室晚电位与多普勒超声左室舒张功能测定的相关分析

对４８例老年冠心病患者及２０例健康老年人作心室晚电位（ＶＬＰ）和彩色多普勒超声左心室舒张功能测定。结果显示：冠心病组ＶＬＰ阳性率比健康组显著升高（分别为３３．３％及０％，Ｐ＜０．０１），左心室舒张功能较健康组明显降低；ＶＬＰ阳性组与阴性组比较，前者左室舒张功能降低更明显；左室舒张功能参数（Ａ／Ｅ比率）与ＶＬＰ各指标（ＱＲＳ时限、Ｄ（４０）、Ｖ（４０））之间有直线相关关系。     

心肌病患者心室晚电位检测意义

心肌病患者心室晚电位检测意义云南省昆明市第一人民医院翟彪，田青，王纬心室晚电位（ＶＬＰ）检测有助于预报恶性快速室律异常，其与心肌梗塞发生恶性室律异常的关系已有很多报道，而与心肌病发生恶性室律异常的关系报道不多。本文对正常人、心肌梗塞及心肌病分组进行信...     

三项无创性检查对预测心脏性猝死的价值

心脏性猝死是由于心脏原因引起的意外的自然死亡，是心血管疾病最严重的并发症。如何发现高危人群并加以防治是当前医学研究的重点。心室晚电位（ＶＬＰ）、动态心电图（Ｈｏｌｔｅｒ）及心率变异性（ＨＲＶ）等检查对缺血性心脏病所发生的猝死均有一定的预测价值，但敏感性及阳性预测值不高。本文旨在探讨ＶＬＰ、Ｈｏｌｔｅｒ和ＨＲＶ联合应用对心肌缺血患者发生猝死的预测价值。　　病例选择　心肌缺血患者共１３８例，年龄３７～８１岁，均为心内科住院患者。其中急性心肌梗塞４３例，陈旧性心肌梗塞１８例，其余７７例为经Ｈｏｌｔｅｒ…     

急性心肌梗塞的溶栓疗法对心室晚电位的影响

本文观察了６０例急性心梗病人，溶栓对心室晚电位（ＶＬＰ），持续性室速（ＶＴ）及死亡率的影响。临床发现，溶栓组ＶＬＰ的检率３例（１０％），持续性室速的发生率６例（２０％），死亡率３例（１０％），非溶栓组分别为１０例（３３％），ＶＴｌ５例（５０％），死亡率１０例（３３％），二组相比有显著差异（ｐ＜０．０５）。再通组ＶＬＰ的检出率１例（４．３％），ＶＴ的发生率２例（４．３％），非再通组分别为２例（２８％）和４例（５７％），二组相比有显著差异（Ｐ＜０．０５和Ｐ＜０．０１）。再通组与非再通组的死亡率无显著差异（Ｐ＞０．０５）。因此，本文提示溶栓能降低心梗病人ＶＬＰ及ＶＴ的发生率，降低心梗病人的死亡率。     

心肌梗塞的心室晚电位研究

本文对50例心肌梗塞(MI)病人的心室晚电位(VLP)检测结果进行定性与定量分析:(1)MI组与正常组之间存在着显著性差异(P<0.001),提示VLP是一种病理性的电活动;(2)不同部位MI的VLP阳性检出率下壁为38％、前壁为35％、前间壁为33％、前侧壁为20％,提示下壁MIVLP的阳性检出率较高。此外,根据对VLP定量分析的结果发现,下壁、前间壁MI对反映传导和电压的指标均敏感。而前壁、前侧壁MI仅对反映传导的指标敏感,其机理需进一步探讨;(3)急性心肌梗塞与陈旧性心肌梗塞组都有形成VLP的可能,但前者检出率相对较高。由此提出应根据不同发生机制而采取针对性较强的防止电不稳定的措施;(4)MI伴室性心律失常(VA)组与不伴VA组之间存在着显著性差异(P<0.001),提示VLP阳性者VA的发生率较高。     

陈旧性心肌梗塞患者心室晚电位与临床关系探讨

本文对50例陈旧性心肌梗塞（OMI）患者利用动态心电图（DCG）分析系统进行了心室晚电位（VLP）检测，并以90例正常人作对照。结果发现：①OMI患者VLP阳性率为22％（11／50例）；②OMI患者在VLP检测时有非持续性室速者VLP阳性率为75．0％（3／4例），而无非持续性室速者VLP阳性率为17．4％（8／46例），二者相比，差异十分显著（P＜0．01）；③VLP阳性与梗塞部位、室性早搏情况、心功能不全、室壁瘤形成等无明显相关。     

Localization of the optimal site for the detection of late potentials]

Late potentials (VLP) are high frequency-low amplitude electrical potentials that appear at late ventricular depolarization. A multilead method of detection (method M) was adopted in the present study. This study was designed to compare method M with composite XYZ lead method (method C) by analysis of signals recorded from the same hardware system. The purpose was to find out relations of the directions of MI Q vector and peri-infarction block to the recording lead axes of VLP. In 44 MI patients the results of VLP detection indicated that: (1) The positive incidence of VLP detection was 55% with method M which was significantly higher than that with method C (25%, P less than 0.01) especially in patients with ventricular tachycardia and/or ventricular fibrillation and ventricular premature contractions. The sensitivity of VLP with method M (75-88%) was apparently higher than that with method C (38%). (2) The direction of Q vector in MI was closely correlated with that of recording lead axes of VLP. (3) The positive VLP were found around peri-infarction block in patients with MI. The direction of peri-infarction block was mostly in line with that of lead axes with positive VLP, that is, the positive rate of VLP detection was the highest when ever the vector of MI and peri-infarction block were parallel to the recording lead axes of method M.     

信号平均心电图频谱时间标测检测冠心病及持续性室性心动过速／心室颤动患者结果的分析

目的：本研究观察了频谱时间标测检测心室晚电位心室对冠状动脉粥样硬化性心脏病（冠心病）患者持续性室性心动过速（室速）／心室颤动（室颤）发生的预测价值，并观察了心肌梗死、缺血及心肌梗死部位对心室晚电位的影响。方法：用频谱时间标测法，对２１０例健康人（Ⅰ组）、２０２例冠心病心绞痛患者（Ⅱ组）、１００例陈旧性心肌梗死患者（Ⅲ组）及３９例心肌梗死并持续性室速／室颤患者（Ⅳ组）的信号平均心电图进行分析，根据健康人的正常因子值确定心室晚电位诊断标准，并用Ｘ２检验对各组患者心室晚电位阳性率进行比较。结果：心室晚电位阳性率Ⅰ组与Ⅱ组无显著差异（Ｐ＞０．０５）；Ⅲ组与Ⅳ组显著高于Ⅰ组（Ｐ均＜０．００５）及Ⅱ组（Ｐ均＜０．００５）；Ⅳ组显著高于Ⅲ组（Ｐ＜０．００５）。不同心肌梗死部位无显著差异（Ｐ＞０．０５）；多部位与单部位心肌梗死无显著差异（Ｐ＞０．０５）。预测的敏感性为５１．３％、特异性为９１．０％、阳性预告值为３５．１％、阴性预告值为９５．２％。结论：频谱时间标测检测心室晚电位对预测持续性室速／室颤的发生有重要价值，心肌梗死部位、心肌缺血对心室晚电位的发生无影响。     

Assessment of autonomic function in patients with acute myocardial infarction or diabetes mellitus by heart rate variability, ventricular late potential and QT dispersion.

To compare the efficacy and sensitivity of heart rate variability (HRV), QT dispersion (QTd) and ventricular late potential (VLP) examination in judging autonomic function. Thirty three patients with acute myocardial infarction (AMI) and 33 patients with diabetes mellitus (DM), all of whom were diagnosed with autonomic neuropathy determined by a standard test of cardiovascular autonomic function, were examined by HRV (timing domain methods), QTd and VLP. Thirty three normal individuals served as controls. The mean SD of the normal R-R interval (SDNN) in both the AMI and DM groups was significantly less than that in the control group (p< 0.01); and of course, the QTd of these groups was significantly greater than that of the controls (p< 0.01). The VLP positive rate of the AMI and DM groups were much higher than that of the control group (p< 0.001). SDNN was shown to be significantly negatively correlated to QTd (r= -0.45); and significantly negatively correlated to VLP (r= -0.47); QTd was shown to be positively, though not significantly, correlated to VLP (r=0.48). QTd could be looked as sieving index; HRV could be looked as routine examination of cardiovascular autonomic function, especially SDNN; the combination of HRV and VLP could improve the accuracy of diagnosis.     

The relation between ventricular late potential and ventricular arrhythmia in different stages of acute myocardial infarction]

50 cases of acute myocardial infarction (AMI) were examined for ventricular late potential (VLP) six times in total within 4 weeks. At the same time the patients clinical condition was observed. It is found that: (1) In our group the occurrence of VLP in AMI was 28% and VLP was unstable in both acute stage and recovery stage. (2) During acute stage, the difference of positive VLP rate is significant between the ventricular fibrillation group and normal rhythm group (P less than 0.05), but there is no significant difference between the ventricular ectopia group and normal rhythm group. During recovery stage, the difference of positive VLP rate is very significant between the ventricular ectopia and normal rhythm group (P = 0.001). As there was only 1 case of ventricular fibrillation occurring in the recovery stage, no comparison could be made. (3) There is no correlation between VLP and clinical conditions, such as age sex, location of the infarction, existence of old infarction and LVEF. However, the difference of the peak serum CPK level is significant between VLP positive and negative group (P less than 0.05).     

心室晚电位、心率变异对急性心肌梗死患者心律失常事件发生的预测价值

目的 了解心率变异(HRV)、心室晚电位(VLP)在预测急性心肌梗死(AMI)预后的价值。方法 40例AMI患者HRV(SDNN)、VLP测定,与40例正常人进行对比分析。结果 AMI组SDNN(87.9±25.07ms)与对照组(13.37±35.96ms)比较明显减低(P<0.001),AMI组VLP阳性(11例)与正常组(1例)比较明显增高(P<0.01)。梗塞患者室性心律失常事件组与非事件组HRV(SDNN)、VLP比较相差显著(P<0.005)。对心律失常事件发生预测方面,HRV特异性为93.55％,相对危险性为10.50,VLP敏感性为44.4％。二者结合特异性、相对危险性增加。结论 二项指标均有独立的预测价值,如同时检测可望提高阳性预测值。     

Value of signal averaged electrocardiogram for prediction of successful coronary artery thrombolysis

In 60 patients with acute myocardial infarction (AMI) treated with brief i.v. infusion of streptokinase, signal averaged surface ECG as well as 24-hour ECG were recorded within the first 6 hours after admission and 5 to 10 days later. Results obtained from a group with presumed reperfusion (early plasma creatine kinase activity peak, cessation of pain, decrease in ST segment elevations, the appearance of "reperfusion arrhythmias"), were compared to those from patients with no reperfusion. The first recording showed a higher incidence of ventricular late potentials (VLP) in the group with reperfusion (77% vs. 44%, p less than 0.01), and a smaller difference in the incidence of complex ventricular arrhythmias (89% vs. 68%, p = 0.06). In the period between the two recordings, the incidence of VLP decreased in higher proportion in the same group (p less than 0.025). The incidence of complex ventricular arrhythmias was similar in both groups in the second recording. The authors conclude that complex ventricular arrhythmias following successful thrombolytic therapy occur together with "reperfusion VLPs", which are a better marker for successful thrombolysis in patients with AMI than a high grade of ventricular ectopic activity.     

小剂量倍他乐克对老年急性心肌梗死后心室晚电位干预的研究

目的　探讨小剂量倍他乐克对老年急性心肌梗死 (AMI)后心室晚电位 (VLP)长期干预的作用。方法　将 1 68例老年 AMI后 VLP阳性患者随机分为两组 ,86例干预组患者服倍他乐克 6.2 5～ 2 .5 mg/次 ,2次 /d,82例对照组常规服消心痛。结果　小剂量倍他乐克干预后能使 VLP转阴 (74/86) ,使 SA- ECG的 TD- QRS、LAS较治疗前缩短 ,RMS增加 (P<0 .0 1 ) ,并有效控制室性心律失常发生。结论　小剂量倍他乐克长期干预能使老年 AMI患者 VLP转阴 ,同时又避免大剂量快速用药所致副作用。老年 AMI患者出现 VL P阳性如无明显β-阻滞剂禁忌 ,应首选小剂量倍他乐克长期治疗。