QT离散度与急性心肌梗死合并室性心律失常及近期预后关系的探讨

Correlation of QT dispersion with acute myocardial infarction plus ventricular arrhythmia and early prognosis

目的 为探讨 QT离散度 (QTd)的临床意义 ,进一步评价其对急性心肌梗死 (AMI)合并室性心律失常 (VA)的诊断价值。方法 观察了 132例急性心肌梗死 (AMI组 )及 45名正常人 (对照组 )的最长 QT间期(QTm ax)、校正 QTmax(QTcmax)、最小 QT间期 (QTmin)、校正 QTm in(QTcmin)、QT离散度 (QTd)及心率校正 QTd(QTcd)的变化。结果 1AMI组 ,QTmax、QTcmax、QTd及 QTcd均显著高于对照组 ,P<0 .0 1。2 AMI合并室性心律失常组 (VA组 ) ,QTmax、QTcm ax、QTd及 QTcd均显著高于无室性心律失常组 (NVA组 ) ,P<0 .0 1。3AMI患者 QTcd≥ 6 0 ms者 ,其 VA发生率显著高于 QTcd<6 0 ms者 ,P<0 .0 1。4AMI死亡组 QTmax、QTcm ax、QTd均显著高于存活组 ,P<0 .0 1,死亡组 QTcd高于存活组 ,P<0 .0 5。5 AMI患者 QTcd≥ 80 ms者其室颤 (VF)发生率显著高于 QTcd<80 ms者 ,P<0 .0 1。结论 QTd或 QTcd可作为判断 AMI发生室性心律失常及近期预后的临床参考指标。

Objective To discuss the clinical significance of QT dispertion and make a further assessment of the value for acute myocardial infarction (AMI) patients with ventricular arrhythmia (VA) and early prognosis.Method The changes of maximal QT interval (QTmax),corrected QTmax (QTcmax),minimal QT interval (QTmin),corrected QTmin (QTcmin),QT dispersion (QTd) and corrected QTd (QTcd) in 132 cases of acute myocardial infarction (AMI) and 45 cases of healthy controls were studied.Results ①In AMI group,the QTmax,QTcmax,QTd and QTcd were significantly higher than those in healthy controls (P<0 01).②In AMI with ventricular arrhythmia (VA) group,the QTmax,QTcmax,QTd and QTcd were higher than those in non-ventricular drrhythmia (NVA) group (P<0 01).③In AMI patients,the incidence of VA in those with QTcd≥60 ms was much higher than those with QTcd<60 ms,P<0 01.④In the death group of AMI,the QTmax,QTcmax and QTd were significantly higher than that in survival group (P<0 01).The QTcd in death group was higher than those in survival group (P<0 05).⑤In AMI patients,the incidence of ventricular fibrillation (VF) in those with QTcd≥80 ms was significantly higher than those with QTcd<80 ms(P<0 05).Conclusion The QTd and QTcd can be used as a clinical reference index for judging the incidence of VA (in AMI) and early prognosis.