胺碘酮与索他洛尔对QT离散度的影响及QT离散度改变对治疗室性心律失常的疗效预测价值

Effects of Amiodarone and Sotalol on QT Dispersion and the Value of QT Dispersion Changes in Predicting the Efficacy of Antiarrhythmic Drugs Against Ventricular Arrhythmias

目的通过观察室性早搏(室早)患者治疗前后同步12导联心电图中QT离散度(QTd)及24小时动态心电图变化,分析胺碘酮和索他洛尔作用机制以及QTd应用的临床意义。方法室早患者60例包括Ⅰ组(胺碘酮静脉+口服),Ⅱ组(胺碘酮单纯口服)和Ⅲ组(索他洛尔口服),每组20例。所有患者均在用药前、用药后5天分别检测QT离散度(包括正常波QTd、室早波QTd及室早波随后正常波QTd),以及用药前、用药后两周分别做24小时动态心电图。结果所有患者用药前和用药后正常波QTd有明显的统计学差别(P<0.001),但用药前和用药后5天室早波QTd及室早随后正常波QTd无明显的统计学差别(P>0.05)。Ⅰ组患者总有效13例(65%),Ⅱ组患者总有效13例(65%),Ⅲ组患者总有效11例(55%)。Ⅰ组与Ⅱ组疗效较Ⅲ组为高,但经统计学检验无明显差别(P>0.05)。将所有患者按治疗后有效和无效分为两部分,有效部分和无效部分用药前和用药后5天QTd测定值均有明显的统计学差别(P<0.001),但两部分用药前后QTd差值无明显统计学差别(P>0.05)。结论胺碘酮和索他洛尔治疗效果相似,两者均可降低室早患者的QTd。QTd对于抗心律失常药物疗效无预测价值。

Objective： To observe the effects of amiodarone and sotalol on QT dispersion （QTd） , value of QTd changes in predicting the efficacy of antiarrhythmic drugs and the ventricular arrhythmias. Methods： Sixty patients were randomized to three groups： group 1 receiving intravenous amiodarone followed by oral amiodarone ; group 2 taking only oral amiodarone ; group 3 taking oral sotalol. QTd was assessed before and five days after drug administration. 24 h ambulatory electrocardiographic examination was performed before and two weeks after drug administration. Results： There was a significant difference in sinus beats（QTd-s） before and after drug administration（P 〈0.001）. There were no significant differences in QTd of ventricular extrasystoles （QTd-v） and in QTd of the sinus beats immediately following ventricular extrasystoles（QTd-sv）before and after drug administration（P〉0.05）. In patients of groups 1, 2 and 3 the total response rates of the regimen were 65% , 65% and 55%, respectively. The total response rates of group 1 and group 2 were higher than group 3, but the difference was not significant （P〉0.05）. Between the patients who responded well to the treatment（group 1） and who failed to respond to（ group 2 ） , significant differences in QTd before and after drug administration were observed（P〉0.05）. There were no significant differences in QTd changes between the two groups（P〉0.05）. Conclusion： The curative effects of amiodarone and sotalol were similar. Both drugs can reduce QTd. QTd cannot predict the efficacy of ventricular arrhythmia treatment.