维持性血液透析患者QT间期离散度与室性心律失常的关系及其影响因素

Correlation of QT dispersion with ventricular arrhythmias and its influencing factors in maintenance hemodialysis patients

目的检测60例尿毒症行维持性血液透析(MHD)患者透析前后QT间期离散度(QTd)的变化,初步探讨MHD患者QTd与室性心律失常的关系及其影响因素。方法选择南方医科大学第三附属医院血液净化中心60例MHD患者分别于透析前及透析后记录12导联同步心电图,计算QTd值,并进行临床及相关实验室检查,进行统计学分析。结果存在室性心律失常的MHD患透析前QTd高于无室性心律失常患者(50.84±13.56比39.57±14.72,P<0.01);透析后QTd较透析前明显增大(59.73±20.11比44.23±13.26,P<0.01);回归分析表明,透析后QTd的增幅与K+浓度的变化及HCO3-的变化幅度呈正相关(分别为r=0.67,P<0.01;r=0.79,P<0.01)。结论 MHD患者QTd与室性心律失常的发生有关;透析后QTd进一步增大;QTd增大的机制与K+浓度的快速变化及酸中毒的快速纠正有关。

Objective To investigate the change of QT dispersion （QTd） in 60 patients with uremia undergoing maintenance hemodialysis （MHD）, the relationship between QTd and ventricular arrhythmia in MHD patients, and the factors relating to QTd. Methods 12-lead ECG was conducted in 60 MHD patients before and after dialysis, and their QTds were calculated. Clinical observation, laboratory examinations and statistical analysis were performed. Results Before hemodialysis, QTd values were higher in patients with ventricular arrhythmias than those without ventricular arrhythmias （50.84±13.56 vs 39.57±14.72,P0.01）. QTd values became higher after hemodialysis （59.73±20.11 vs 44.23±13.26,P0.01）. Regression analysis showed that the magnitude of QTd increase positively correlated with the magnitude of K＋ and HCO3- concentration changes （r=0.67, P0.01, and r=0.79, P0.01, respectively） after hemodialysis. Conclusion QTd value may relate to the presence of ventricular arrhythmias in MHD patients. QTd increases further after hemodialysis, probably resulting from the rapid change of serum K＋ concentration and rapid correction of acidosis.