急性心肌梗死后心动室晚电位的演变及随访

Clinical Study on the Evolution and Following-up for One Year of Ventricular Late Potentials after Acute Myocardial Infarction

目的：探讨心室晚电位识别心肌梗死高危病人的预测价值。方法：用体表信号平均心电图的时城分析法，动态观察141例急性心肌梗死患者心室晚电位的演变并做1年随访研究（分为猝死组与无猝死组），分析比较不同时间记录的心室晚电位阳性率及其参数，分析随访期心室晚电位的预测价值。结果：心肌梗死急性期有85。6%病人保持前一次心室晚电位明性或阳性的结果不变，前后二次各项参数的均值差异无显著性（P＞0．05）并呈高度相关（γ=0．68～0．91，P＜0．01）；随访期相当一部分病人的心室晚电位自然消失，猝死组与无猝死组的晚电位阳性率有显著差异（P＜0．05），晚电位预测猝死的敏感性、特异性、准确性、阳性和阴性预测值分别为77．8％、68．1％、68．8％、16．3％和97．5％。结论：心肌梗死急性期的心室晚电位检测具有很高的重复性；无论是心肌梗死急性期还是随访期的晚电位对识别心肌梗死高危病人均有重要价值。

Objective: To study the value of ventricular late potentials (VLP) in predicting high dangerous patients after a-cute myocardial infarction (AMI). Methods:The evolution of VLP in 141 patients with AMI was investigated dynamicallyy from dayto day and the follwing - up for one year after AMI was studied ( the patients wre divided into sudden death grpup and no suddendeath group)by time-domain analysis of signal - averaged electrocardiogram. The incidence of VLP and it's parameters weredetected in defferent time were analysed and compared. The predictive value of VLP was assessed during a follow - up period.Result:During acute period of AMI, there were 85.6% patients who retained the positive or negative result of VLP, and therewas no significant difference (P>0.05)but high correlativity (r=0.68-0.91,P<0.01)between parameter(Total QRS,Un-der40 and ARS40)neans in front and behind times each. Duing follow - up period of myocardial infarction , the VLP of quie partpatients can disappear naturally, and there was significantly different in the incidence of VLLP between sudden death group and nosudden death group. The sensitivity, specificity, predictive accuracy, positive predictive and negative predictive value of VLP forsudden death was 77.8%,68.1%,68.8%,16.3%and 97.5% respectively. Conchusion:VLP detection has highly repro-ducitibility during acute period of myocardial infarction. VLP has important prognostic significance for high dangerous post-in-farction patients regardless of acute or follow-up period of AMI.