急性心肌梗塞早期再灌注对QTc离散度的影响

EFFECTS OF EARLY REPERFUSION BY INTRAVENOUS THROMBOLYSIS WITH INFARCT-ARTERY IN AMI ON QTC DISPERSION

目的 观察４７ 例急性心肌梗塞（ＡＭＩ） 患者，早期再灌注对ＱＴｃ 离散度的影响。方法 对４７ 例ＡＭＩ予以静脉溶栓，并于溶栓后第２４ 小时，判定是否再通。在溶栓前及溶栓后作同步记录１２ 导联心电图测量ＱＴｃｄ 与５０ 例健康者进行对照。结果 ＡＭＩ组溶栓前与对照组间ＱＴｃｄ 差异有极显著性（８２１ ±１１５ｍｓ ＶＳ ３７８ ±１６７ｍｓ Ｐ＜ ０００１） ，前壁与下壁梗塞之间ＱＴｃ 离散度差异无显著性。静脉溶栓后２４ 小时ＱＴｃｄ 显著降低（８３１ ±１１２ｍｓ ＶＳ ５６２ ±１４８ｍｓ Ｐ＜ ０００１） ，而未再开通组ＱＴｃ 在溶栓前后始终保持着较高水平，恢复速度显著慢于开通组。１１ 例溶栓前有恶性心律失常者其ＱＴｃｄ 明显长于无心律失常者（９３１ ±８２ｍｓ ＶＳ８１２ ±１１０ｍｓ， Ｐ＜ ００５） ，溶栓后再通ＱＴｃｄ 降至６２３ ±８４ｍｓ，室性心律失常消失。结论 成功地溶栓再灌注可使ＱＴｃｄ 显著降低。

Objective: To evaluate the effects of early reperfusion with thrombosis on infarct-artery on QTc disperdion(QTcd). Methods: 47 acute myocardial infarction(AMI) patients and 50 normal subjects were studied. QTcd was measured before and after intravenous thrombolysis therapy in AMI patients. Pateney of infarct-related coronary artery was assessed by uniform clinical criteria. Results: QTcd was significantly longer in parients than that of control group. There was no significant difference in QTcd between anterior AMI and inferior AMI, 24 hour after intravenous thrombolysis, QTcd decreased significantly in patency group and remained unchanged in non-patency group. 11 patients associated with malignant ventricular arrhythmias and with longer QTcd, achieved a significant reduction of QTcd and disappearance of ventricular arrhythamias after thrombolysis. Conclusion: Successful early reperfusion with infarct-related artery can reduce QTcd and decreacs the risk of ventricular arrhythmia in AMI patients.