急性心肌梗塞溶栓治疗对QT离散度的影响

The Effect of Thrombolytic Therapy on QT Dispersion after Acute Myocardial Infarction

目的观察急性心肌梗塞（AMI）患者溶栓治疗对QT和JT离散度的影响。方法60例AMI患者于静脉溶栓治疗后90min以Judkins法行冠状动脉造影估价梗塞相关动脉（IRA）前向血流情况，并观测其溶栓前和溶栓后每30min直至2h的QT和JT离散度变化以及72h内恶性室性心律失常的发生情况。结果34例IRA血流达到心肌梗死溶栓试验2～3级者，溶栓后2hQT和JT离散度显著降低，而24例IRA未开通者上述指标在溶栓前后始终保持较高水平。18例有恶性室性心律失常者QT和JT离散度明显高于无心律失常者（125±47ms和110±35ms，84±45ms和81±40ms）（P均＜0．01）。结论成功溶栓治疗可使QT和JT离散度显著降低，减少心律失常发生的危险性。

Objective To study the effects of intravenous thrombolytic therapy on QT or JT interval dispersion after acute myocardial infarction (AMI). Methods 60 AMI patients had undergone Judkins' coronary angiography 90 minutes after intravenous thrombolytic therapy. The antegrade blood flow of infarct-related coronary artery (IRA) was assessed,QT or JT interval dispersion were calculated before and every 30 minutes after thrombolytic therapy within 2 hours. Meanwhile severe ventricular arrhythmias were monitored during 72hours. Results QT or JT interval dispersion was significantly reduced in 34 patients, whose IRA was successfully reperfused (TIMI flow grade 2 or 3) within 2 hours after thrombolytic therapy, whereas it was unchanged in the remaining 26 patientS with TIMI flow grade 0 or 1.The QT or JT interval dispersion was significantly higher in 18 patients with severe ventricular arryrhmias (125±47ms and 110±35ms) than in 42 patients without severe ventricular arrhythmias (84±45ms and 81±40ms, all P＜0.01. Conclusion The study indicates that successful thrombolytic therapy of acute myocardial infarction may reduce a risk of ventricular arrhythmia by decreasing QT or JT interval dispersion.