急性心肌梗塞 QT 离散度变化与室壁运动异常的关系

Relation between increased QT dispersion of acute myocardial infarction and regional wall motion abnormality

观察２８例急性心肌梗塞（ＡＭＩ）患者和３０例稳定性劳力型心绞痛患者室壁运动异常（ＲＷＭＡ）的范围和程度与ＱＴ离散度（ＱＴｄ）变化的关系。结果：①ＡＭＩ组早期即存在明显的ＲＷＭＡ，其ＲＷＭＡ的程度记分明显高于劳力型心绞痛患者。ＡＭＩ后１周、４周的ＱＴｄ值较对照组显著延长。②ＱＴｄ值随ＲＷＭＡ程度加重而逐渐延长，前侧壁ＡＭＩ的ＲＷＭＡ范围比下后壁ＡＭＩ显著为大，相应ＱＴｄ亦显著延长。ＡＭＩ后１周、４周ＱＴｄ值与ＲＷＭＡ的范围和程度记分乘积呈显著正相关（ｒ＝０．７８，ｒ＝０．７１，Ｐ均＜０．０１）。③溶栓再通组发病后１周、４周的ＱＴｄ值较非溶栓组明显减少，前者ＲＷＭＡ程度记分及范围亦较后者显著减少。结论：ＡＭＩ后ＱＴｄ显著延长，并与ＲＷＭＡ程度加重及范围扩大呈密切相关。

In order to explore the relation between increased QT dispersion (QTd) and left ventricular regional wall motion abnormality(RWMA) in acute myocardial infarction(AMI),the QTd and the extent and degree of RWMA in 28 patients of early AMI and in 30 cases of effort angina(control group) were measured. The results:1. In AMI group there was serious RWMA,while in control group the severity of RWMA was mild and the calculated fraction of RWMA degree was lower than that in AMI group. The QTd in AMI group was longer than that in the control group. 2. The extent of RWMA in anterolateral wall AMI group was more significantly enlarged than that in inferoposterior wall AMI,the QTd was also longer in anterolateral wall AMI than in inferoposterior wall AMI. The QTd was significantly correlated with the product of the extent and degree of RWMA(P<0.01). 3. The QTd of the patients with successful reperfusion by thrombolytic therapy was more significantly decreased than that of the patients by non thrombolytic therapy(P<0.05),while the extent and degree of RWMA in the lower QTd patients were more significantly reduced than in the higher QTd patients. The results showed that the QTd in early AMI was higher than in effort angina and the QTd change was close correlated with the extent and degree of RWMA. The thrombolytic therapy could reduce the QTd and the extent and degree of RWMA in the patients of early AMI.