心室复极指标对急性心肌梗死恶性室性心律失常的预测价值

目的:探讨J波、ST段墓碑型抬高、Q-T间期离散度(QTd)、J-T间期离散度(JTd)预测急性心肌梗死(AMI)后恶性室性心律失常的价值.方法:回顾性分析2000年1月至2010年12月住院临床确诊的173例急性ST段抬高型心肌梗死患者的心电图(ECG)及其相关资料,根据ECG结果分为J波组(n=57)、ST段墓碑型抬高组(n=52,其中26例兼有J波出现)和通常组(n=90),J波组、ST段墓碑型抬高组分别与通常组比较QTd、JTd及恶性室性心律失常的发生率.结果:J波组、ST段墓碑型抬高组的QTd、JTd分别为(75.1+22.0)ms、(72.9±23.9)ms和(71.4±21.3)ms、(69.0±25.0),均明显高于通常组的(59.0±17.9)ms和(53.3±18.4)ms,P均＜0.01；J波组、ST段墓碑型抬高组的恶性室性心律失常的发生率分别为31.6％、28.8％,均明显高于通常组的10％,P均＜0.01.结论:心电图心室复极异常指标J波、ST段抬高、QTd、JTd延长均可作为AMI患者恶性室性心律失常的预测指标.

Indexes of Ventricular Repolarization in Predictive Value to Malignant Ventricular Arrhythmia in Patients with Acute Myocardial Infarction

Objective： To explore the value of J wave, tombstone of ST segment, Q-T dispersion （QTd）and J-T dispersion （JTd） in the prediction of malignant ventricular arrbythmia （MVA） after acute myocardial infarction （AMI）. Method： ECG and clinical data of 173 patients with ST segment elevation myocardial infraction （STEM）were analyzed retrospectively from Jan 2000 to Dec 2010.They were divided into J wave group （n=57）,tombstone ST segment group（n=52,26 cases with J wave）and normal group（n=90）. Both the .I wave group, tombstone ST segment group and the normal group were compared in QTd,JTd and incidence of MVA. Results： The QTd and JTd were significantly higher in J wave group （75.09±21.97ms, 71.40±21.33ms） and tombstone ST segment group （72.9±23.9ms, 69.0±25.0ms）than those in the normal group （59.0±17.9ms,53.3±18.4ms） （all P 〈0.01）. The incidence of MVA were significantly higher in J wave group （31.6%） and tombstone ST segment group （28.8%） than that in the normal group （10%）（both P〈0.01 ）. Conclusion： Indexes of ventricular repolarization of ECG with J wave, tombstone ST segment, longer QTd and longer JTd may predict MVA after AMI.