QT离散度在急性冠脉综合征中的临床意义及PCI术后QT离散度的变化研究

目的 探讨急性冠脉综合征（ACS）中体表心电图QT离散度（QTd及QTcd）的变化、冠状动脉严重狭窄行PCI术后及PCI术时应用替罗非班其QTd及QTcd的变化.方法 回顾性分析2010年2月份至2013年6月份行冠状动脉造影检查的312例急性冠脉综合症患者的临床资料,测量分析其心电图QT离散度的变化.把已行PCI术患者的QT离散度与其PCI术前的QT离散度进行对比,观察其变化.对行PCI术的36例未用替罗非班患者的QT离散度与30例行PCI术时应用替罗非班的患者的QT离散度对比分析.结果 急性冠脉综合征组体表心电图QT离散度数值比冠状动脉正常组明显增大.其中,不稳定型心绞痛组中二支病变组比一支病变组增大,三支病变组大于双支病变组,心肌梗死组较冠状动脉正常组显著增大.PCI术后其QTd及QTcd较PCI术前明显降低,近似接近正常组.PCI术组应用替罗非班后其QTd及QTcd值较未用替罗非班组小,能够显著降低缺血性心肌的QT离散度,改善预后.结论 体表心电图QT离散度的改变对判断冠状动脉病变血管支数及心肌急性缺血状态具有一定的价值.

Clinical significance of QT dispersion in patients with coronary syndromre and QT dispersion changes after PCI

Abstract： Objective To observe the QT dispersion changes in the surface ECG in acute coronary syndrome, and after PCI of coronary stenosis was and QT dispersion changes when tirofiban was used in PCI. Methods The clinical records of 312 patients whose coronary angiography showed acute coronary syndrome from February 2010 to June 2013 were retrospectively analyzed and their QT dispersion changes were measureed and analyzed. QT dispersion in patients undergoing PCI was compared with preoperative QT dispersion. QT dispersion of 36 patients undergoing PCI without tirofiban was compared with QT dispersion of 30 patients undergoing PCI with tirofiban. Results The QTcd dispersion values in acute coronary syndrome group were significantly larger than normal coronary arteries. Among them, the unstable angina group two lesions larger than one lesion group, three lesions greater than double vessel disease, myocardial infarction group compared with normal coronary arteries had significant increase. QTcd after PCI was significantly lower than before PCI, approximately near normal group. QTd and QTcd in PCI, with tirofiban group after the application of tirofiban, can significantly reduce the QT dispersion of isehemie myocardium prognosis. Conclusions QTd or QTcd changes have a certain value on the judgment of coronary arteries and myocardial ischemie state.