直接经皮腔内冠状动脉成形术对急性心肌梗死早期24小时心电稳定性的干预

The Effect of Primary Percutaneous Transluminal Coronary Angioplasty on the Stability of Cardiac Electricity During 24 Hours in the Early Acute Myocardial Infarction.

为探讨直接经皮腔内冠状动脉成形术 (P PTCA)对急性心肌梗死 (AMI)早期 2 4h心电稳定性的影响 ,对发病≤ 6h并接受P PTCA治疗的 2 2例AMI患者 (P PTCA组 )进行动态心电图监测 ,持续观察其 2 4hQT间期值 (QT)和室性心律失常等心电指标变化 ,并与 15例梗死相关动脉 (IRA)未通患者 (对照组 )作对比。结果 :①P PTCA组的QT 2 4h内逐渐延长 ,其最小值 (术前 1h ,34 6± 16ms)与最大值 (术后第 2 3小时 ,391± 16ms)有显著性差异 (P <0 .0 1) ,与对照组的变化趋势类同。②P PTCA术前的心率校正QT(QTc)为 388± 15ms ,于术后开始迅速显著延长 ,至第 2小时达高值 (42 8± 17ms)后轻度缩短 ,然后又有逐渐延长趋势 ;对照组的QTc变化趋势与QT基本相同。③室性异位激动于P PTCA第 1小时 (5 31± 480次 )较术前 (185± 12 0次 )即迅速增加 ,主要见于术后的 3h内 ;对照组的室性异位激动在 2 4h内散在出现。提示AMI患者于P PTCA早期心电不稳定性增加 ,此为IRA开通和心肌再灌注损伤的临床强力指标之一。

To study the effect of primary percutaneous transluminal coronary angioplasty (P PTCA) on the stability of cardiac electricity during 24 hours in the early acute myocardial infarction (AMI),22 patients (16 males and 6 females,ages 42—74) with AMI treated by P PTCA underwent 24 hours Holter monitoring within 6 hours after the symptom onset.The changes of QT interval (QT),corrected QT for heart rate (QTc) and ventricular arrhythmia were analyzed continually and was compared with the 15 patients (12 males and 3 females,ages 46—68) who had occluded infarct related arteries (IRA).Results showed:①QT and QTc had a tendency to prolong during the 24 hours in two groups,respectively.QTc prolonged remarkably following P PTCA,and reached a higher value at the second hour after the procedure compared with the value before P PTCA (428±17 ms vs 388±15 ms, P <0.01),and then QTc prolonged gradually.②Ventricular arrhythmia was scattered during 24 hours in occluded IRA group,whereas frequent ventricular arrhythmia were observed within the early 3 hours after P PTCA,and the difference of the number of ventricular arrhythmia between 1 hour post and pre procedure is significant (531±480 beats vs 185±120 beats, P <0.01).In Conclusion,the increased unstability of cardiac electricity was showed in the early phase after PTCA.This is a strong clinical marker for IRA opening and myocardial reperfusion damage.