急性心肌梗塞患者QT离散变化及其临床意义

Variability of QT Dispersion in Patients withAcute Myocardial infarction and its ClinicalSignificance.

本文观察了７７例急性心肌梗塞（ＡＭＩ）患者入院时和出院前ＱＴ离散（ＱＴｄ）变化以及８例住院期间猝死的ＡＭＩ患者ＱＴｄ改变，与正常人组和陈旧性心肌梗塞组比较，ＡＭＩ患者入院时平均ＱＴｄ明显大于正常人组和陈旧性心肌梗塞患者（Ｐ＜０．０１）；猝死的ＡＭＩ患者平均ＱＴｄ明显大于６９例有活ＡＭＩ患者；ＡＭＩ用者出院前平均ＱＴｄ较入院时减小（Ｐ＜０．０１）。提示ＡＭＩ患者入院时平均ＱＴｄ增大，猝死者平均ＱＴｄ增大更明显，且较存活者增大。连续观察ＡＭＩ患者急性期体表心电图ＱＴｄ变化，可为评价病情进展和治疗效果提供依据。

T dispersion (QTd) was defined as maxi-mal QT interval minus minirnal QT intervalon the surface electrocardiogram (ECG). Ithas been demonstrated to reflect regional in-homogeneity of ventricular repolarization.This study was designed to explore thechanges on QTd that occur during the acutemyocardial infarction (AMI). The variabilityof QTd on surface ECG ,during admission andbefore discharge were observed in 77 patientswith AMI, include 8 patients that developedsudden death in hospital, 60 normals and 30patients with old myocrdial infarction as con-trol .Results: the average Qtd in patients withAMI significantly greater than those in normalhuman (51±24 ms vs 30± 12 nis P<0. 01).In 8 patients to suffer sudden death,the aver-age QTd was significantly greater than thoseon first ECG in 69 patients with AMI whowithout cardiac events (64± 31 ms vs 50±22ms P<0. 01 ). In patients with AMI at beforedischarge and with old myocadial infraction,the average QTd was shorter respectively thanthose patients with AMI at first ECG (38±15ms vs 51±24 ms P<0. 01 and 39±17 ms vs51±24 ms P<0. 01)Conclusion : QTd is increased during the ear-ly phase of AMI and is graeter in patients whodeveloped sudden death. It suggested thatthere are a significantly greater amount of in-homogeneity at ventracular repolarization inpatients wiht AMI, especially in those who de-veloped suddeh death ,The increased QTd maybe smaller after theraputic intervention.Thus, tracingobservation of QTd on surfaceECG in patients with AMI may assess thehappeness of cardiac events' the diseases'sprocess and the theraputic effects.