前列地尔脂微球载体注射液对急性心肌梗死后QTc离散度的影响

Effect of alprostadil injection (Lipo-PGE_1) on QT intervals dispersions (QTcd) in patients with acute myocardial infarction

目的:观察60例急性心肌梗死(AMI)患者在发病早期应用前列地尔脂微球载体注射液(Lipo-PGE_1)治疗对QTc离散度(QTcd)的影响。方法:60例AMI患者随机分为前列地尔治疗组(n=31)和对照组(n=29)。治疗组在常规治疗基础上加用Lipo-PGE_1,疗程3周;对照组只采用常规治疗方法。记录每例患者入院后用药前和用药后第1,2,3,12,24 h和d3的12导联心电图测定QTcd。结果:入院后给药前测定QTcd治疗组与对照组间差异无显著性[(87．2±125)vs(86．9±11．3)ms,P＞0．05],前壁与下壁梗死之间QTcd差异无显著性[(87．2±12．5)vs (86．7±12．1)ms,P＞0．05]。治疗组在用Lipo-PGE_12 h时QTcd较对照组开始显著降低[(78．5±12．6)vs(87．8±13．6)ms,P＜0．05],24h起QTcd较对照组极显著降低[(66．3±11．3)vs(88．1±13．2)ms,P＜0．01]。治疗组有8例出现室性心律失常,在应用Lipo-PGE_12h后7例消失。结论:Lipo-PGE_1在AMI发病早期应用可降低QTcd,从而减少恶性心律失常发生,减少AMI的死亡率。

Objective ： To evaluate the prophylaxis of QT intervals dispersions （QTcd） with alprostadil injections （ Lipo-PGE1 ） in patients with initial stage of acute myocardial infarction （ AMI ）. Methods： 60 AMI inhospitalized patients were randomly treated with either conventional regimen （n = 29） or conventional regimen plus alprostadil injection （n = 31 ） for 3 weeks. The patients underwent a 12-lead ECG to monitor the QTcd pre-therapy and in 1, 2, 3, 12, 24 hours and day 3 post-therapy. Results： Compared to the conventional therapy of （87.8 ± 13.6） ms, the patients adding on PGE1 initiated the significant reduction of QTed in 2 hours post-therapy （78.5 ±12.6）ms. （P 〈 0.05 ）. The QTcd of the patients injecting PGE1 was （66.3 ± 11.3） ms in 24 hours post-therapy, compared with the conventional therapy of （88.1± 13.2） ms （P 〈 0.01 ）. The PGE1-treated patients experienced ventricular arrhythmias （8 out of 31 patients）, of which 7 incidences were recovered when patients continued the PGE1 therapy for more than 2 hours. Conclusion： Administration of alprostadil at the early stage of AMI episode was beneficial in the reduction of the incidence of malignant arrhythmia and mortality due to AMI.