急性心肌梗塞后QT离散度改变及临床意义

QT Interval Dispersion in Patients with Acute Myocardial Infarction

分析了66例急性心肌梗塞（AMI）病人的QT间期、QTc离散度（QTcd）、JTc离散度（JTcd）、QRS离散度（QRSd）的变化。结果显示除QTcmin、QRSd外，QTcmax、QTcd、JTcd在AMI后48小时内均显著增加；第2周显著降低（P＜0.01），其中溶栓治疗再灌注组较无再灌注和非溶栓组下降更为显著（P＜0．01）；第3～4周再灌注组明显回升（P＜0．01），无再灌注和非溶栓组则无变化，三者间差异无显著意义（P＞0．05）。AMI后发生室颤（VF）／室速（VT）、心室晚电位检查（VLP）阳性者显著高于未发生VF／VT、VLP阴性者。提示AMI早期存在明显的心肌复极不均匀；AMI后发生VF／VT可能与心肌复极离散度有关，QTcd对预测AMI后VF／VT的发生有一定的意义；QTcd还可作为AMI溶栓治疗后再灌注的判断指标之一。

To assess the clinical value of QTc-interval dispersion (QTcd ) in acute myocardial infarction (AMI), the changes of QTcd and some in fluential factors were investigated in 66 patients with AMI. The results were as folows: 1) QTcd in all patients was significantly higher than the normal leve within 48 hours post-myocardial infarction and markedly decreased in two weeds (P > 0. 01 ); 2) QTcd in thrombolytic therapy with reperfusion group was significant lower than that in without reperfusion group and in non-thrombolytic therapy group; 3) Serious increasing of QTcd mainly appeared in the patients with ventricular fibrillation (VF), tachycardia (VT) or VLP +. The findings suggested that there is marked dispersion of repolarization at the early stage of AMI, it might have some relationship to VF / VT and reflect the efficiency of thrombolytic therapy.