急性心肌梗塞后QT离散度的演变及其与室性心律失常的关系

The Relation Between QT Dispersion Evolvement and Ventricular Arrhythmia in Patients with Previous AMI

目的 研究急性心肌梗塞 (AMI)后QT离散度 (QTd)的演变及其对快速室性心律失常的预测价值。方法 测量 34例AMI后患者不同时期和伴室性心律失常时的QTd ,并与健康对照组 (90名 )相比。结果 AMI后患者的QTd在急性期 (72± 18ms)明显大于亚急性期 (5 8± 17ms,P <0 .0 1) ,亚急性期大于陈旧期 (49± 2 1ms,P <0 .0 1) ,均明显大于对照组 (36± 10ms,P <0 .0 1)。陈旧期内心功能Ⅰ级、Ⅱ级者的QTd(36± 14ms,41± 15ms)与对照组无明显差异 (P >0 .0 5 ) ,Ⅲ～Ⅳ级者的QTd(6 6± 2 0ms)明显延长 (P <0 .0 1)。 9例AMI伴室速 /室颤 (VT/VF)者的QTd(91± 18ms)显著长于急性期不伴VT/VF者 (70± 14ms,P <0 .0 1)。结论 AMI后 0～ 3天QTd显著延长 ,随梗塞愈合渐趋正常 。

Objective To study the evolvement of QT dispersion (QTd) and to evaluate it's value in predicting ventricular tachycardia arrhythmia development in patients with a previous acute myocardia infarction (AMI).Method QTd in 34 AMI patients (AMI group) was measured and compared with that in 90 normal subjects (control group).Results QTd in AMI group during acute phase was greater than that during sub acute phase ( P <0.01).The latter also had a greater QTd than that during old phase ( P <0.01).QTd in AMI group was greater than that of control group ( P <0.01).despite of the different phase.QTd significantly increased in OMI patients with cardiac function phase Ⅲ～Ⅳ compared with that in both control group and patients with cardiac function Ⅰ and Ⅱ ( P < 0.01 ).Nine patients with VT/VF had a markedly increased QTd (91±18ms).Conclusion QTd increases in AMI patients during acute phase and decreases gradually later till returning to normal value.The significant prolonged QTd is a sign of fatal ventricular arrhythmia development.