老年缺血性心脏病患者跨室壁复极离散度心电学检测及临床意义

目的探讨老年缺血性心脏病患者跨室壁复极离散度的心电学检测及临床意义。方法选择老年缺血性心脏病患者159例为实验组,健康体检者143例为对照组;2组均行12导联心电图检查,测定T波峰末间期(Tp-e)、QTc、QTd、Tp-e/QTc;行24h动态心电图,实验组根据室性心律失常发生情况分为无室性心律失常组58例,室性期前收缩组76例,室性心动过速组25例;随访6~48个月,根据实验组死亡情况分为死亡组35例、存活组103例及猝死组21例,观察Tp-e、QTd、Tp-e/QTc与室性心律失常、心源性猝死的关系。结果与对照组比较,实验组和猝死组Tp-e、QTc、QTd、Tp-e/QTc明显升高(P<0.05,P<0.01);猝死组Tp-e、QTc、QTd、Tp-e/QTc较存活组和死亡组明显升高(P<0.05);与无室性心律失常组比较,室性期前收缩组和室性心动过速组Tp-e、QTc、QTd、Tp-e/QTc明显升高;与室性期前收缩组比较,室性心动过速组Tp-e、QTc、QTd、Tp-e/QTc明显升高;Tp-e、QTd、Tp-e/QTc与室性心律失常、心源性猝死相关(P<0.05,P<0.01)。结论 Tp-e、QTc、QTd、Tp-e/QTc能够反映老年缺血性心脏病跨室壁复极离散度的变化,其值增大可能是老年缺血性心脏病发生心源性猝死的危险指标。

Clinical significance of ECG in detecting transmural dispersion of repolarization in elderly ischemic heart disease patients

Objective To study the clinical significance of ECG in detecting transmural dispersion of repolarization(TDR)in elderly ischemic heart disease(IHD)patients.Methods One hundred and fifty-nine elderly IHD patients served as an experimental group and 143 subjects undergoing physical examination served as a control group in this study.Patients in experimental group who underwent 12-lead ECG for Tp-e,QTc,QTd,Tp-e/QTc,and 24 hdynamic ECG were divided into non-ventricular arrhythmia group(n=58),ventricular arrhythmia group(n=76),and ventricular tachycardia group(n=25).The patients were followed up for 6-48 months and further divided into death group(n=35),survivor group(n=103),and sudden death group(n=21).The relation of Tp-e,QTc,QTd,Tp-e/QTc with ventricular arrhythmia and cardiogenic sudden death was observed.Results The Tp-e,QTc,QTd,Tp-e/QTc were significantly longer in experimental group and sudden death group than in control group(P<0.05,P<0.01),in sudden death group than in survivor group and death group(P<0.05),in ventricular arrhythmia group and ventricular tachycardia group than in non-ventricular arrhythmia group,and in ventricular tachycardia group than in ventricular arrhythmia group(P<0.05).The Tp-e,QTd,Tp-e/QTc were related with ventricular arrhythmia and cardiogenic sudden death(P<0.05,P<0.01).Conclusion Tp-e,QTc,QTd,Tp-e/QTc can show the TDR in elderly IHD patients,indicating that their increased value is the risk factor for cardiogenic sudden death in elderly IHD patients.