冠脉内超声溶栓对急性心肌梗死患者QTc离散度的影响

The effect of coronary ultrasound thrombolysis in acute myocardial infarction on QTc dispersion

目的 研究冠脉内超声溶栓对急性心肌梗死患者 QTc离散度的影响以探讨超声溶栓对心肌心电生理的影响 ,以及预测危险心律失常的意义。方法 急性心肌梗死患者 30例 ,超声溶栓成功组 (A组 =10例 ) ;超声溶栓 + PTCA组 (B组 =10例 ) ;单行 PTCA成功组 (C组 =10例 )。术前、术后即刻和术后测量QTc离散度。结果 心肌梗死部位 (前壁 AMI与下壁 AMI相比 )对 QT离散度无影响 (P>0 .0 5 ) (术前 :78.6± 6 .4m V vs79.2± 6 .6 m s;术后即刻 :5 3.6± 7.4ms vs5 2 .5± 6 .2 m s;术后 2 h:47.3± 5 .6 ms vs5 0 .3±7.5 ms)。超声溶栓、超声 + PTCA和 PTCA一样可减少 QT离散度 (术前 :78.4± 6 .0 4m s vs79.1± 6 .2 7m svs79.1± 7.39ms;术后即刻 :5 2 .3± 4.5 m s vs5 3.6± 6 .7ms vs5 3.2± 9.5 ms;术后 2 h:49.3± 5 .6 m s vs48.2± 6 .2 m s vs48.9± 7.6 ms,P<0 .0 5 )。结论 经导管超声溶栓可使 QTc显著降低 ,减少心律失常发生 ,对降低心肌梗死可能有临床意义。

Objective This study was conducted to evaluate the effect of coronary ultrasound thrombolysis(CUT) on QTcd in AMI.Methods Consecutive patients(n=30)with evidence of anterior AMI(n=17) and inferior AMI(n=13) were studied.The patients were divided into 3 groups.Group A:10 cases had TIMI(Thrombolysis in Myocardial Infarction)grade 3 flow in the infarct-related vessels following CUT.Group B:In 10 cases TIMI-3 grade flow was not achieved in the infarct-related vessels by CUT,but achieved after rescue PTCA.Group C:10 cases had primary PTCA.Results The location of myocardial infarction had no effects on QTcd ( P >0.05)(pre:78.6±6.4ms vs 79.2±6.6ms;immediately after procedure:53.6±7.5ms vs 52.5±6.2ms;2 hours after procedure:47.3±5.6ms vs 50.3±7.5ms).UT、UT+PTCA and PTCA can decrease QTcd (pre:78.4±6.04ms vs 79.1±6.27ms vs 79.1±7.39ms;immediately after procedure:53.6±6.7ms vs 53.2±9.5ms;post 2h:49.3±5.6ms vs 48.2±6.2ms vs 48.9±7.6ms, P <0.05).Conclusions Coronary ultrasound thrombolysis can reduced QTcd and decreased the risk of arrhythmia in AMI patients.