急性心肌梗死溶栓治疗对Q-T离散度和心率变异性的影响

The Influence of Thrombolysis Therapy on Q-T Dispersions and Heart Rate Variability in AMI Cases

目的 :探讨急性心肌梗死溶栓治疗对Q -T离散度和心率变异性的影响。方法 :观察急性心肌梗死发病 6h内接受溶栓治疗的 6 0例患者 ,按溶栓后冠脉有无再通分为再通组 (36例 )和未再通组 (2 4例 ) ,测定溶栓治疗前后Q -T离散度和溶栓治疗后的心率变异性 (SDNN和RMSSD)。结果 :溶栓前两组Q -T离散度无差异。溶栓后Q -T离散度再通组明显低于未再通组(P <0 .0 5 ) ,再通组明显大于未再通组 (P <0 .0 5 )。在再通组SDNN和RMSSD和Q -T离散度的下降值之间非常显著相关 (Ps<0 .0 1,Pr <0 .0 2 ) ,而未再通组没有发现这种相关性 (P >0 .0 5 )。Lown氏分级 3级以上室性心律失常溶栓前再通组与未再通组无显著性差异 (P >0 .0 5 ) ,溶栓后再通组显著低于未再通组 (P <0 .0 1)。结论 :急性心肌梗死早期有效的溶栓治疗可缩短Q-T离散度 ,提高SDNN和RMSSD ,改善心肌电稳定性和植物神经功能 ,并减少恶性室性心律失常的发生。心率变异和Q -T离散度的下降值之间有一定的相关性 ,两者结合可提高对恶性心律失常发生的预测价值 ,提高对溶栓疗效的判断。急性心肌梗死早期恶性心律失常和猝死的发生除了和Q -T离散度显著增大有关外 ,还有可能与心率变异 (SDNN和RMSSD)的下降有关。

Objective: To study the influence of thrombolysis therapy on Q-T dispersions and heart rate variability in AMI cases. Methods: 60 AMI patient who took the treatments of thrombolysis within 6 hours were investigated, according to the condition of coronary artery after thrombolysis therapy, all the patients were divided into reperfusion group (36 cases) and obstructed group (24 cases), Q-T dispersions and heart rate variability were measured in times before and after thrombolysis. Results: No difference was noted for Q-T dispersions in both groups before the treatment of thrombolysis. After the thrombolysis, the Q-T dispersions of reperfusion group were significantly lower than those of obstructed group ( P <0.05). SDNN and RMSSD of reperfusion group were much greater than obstructed group's. In the reperfusion group, a good correlation was found between the heart rate variability (SDNN and RMSSD) and Q-T dispersion (Ps<0.01, Pr<0.02) while in the obstructed group no correlation was noted ( P >0.05). Ventricular arrhythmia of Lown's 3 grades and more before thrombolysis had no difference in the two groups ( P >0.05), but the reperfusion group was much lower than the obstructed group after the thrombolysis ( P <0.01). Conclusion: Effective thrombolysis therapy for AMI cases in early stage can reduce the Q-T dispersion and improve the SDNN and RMSSD, amend the electric stability of myocardium and the function of vegetative nerve, cut down the occurrence of malignant ventricular arrhythmia. The combination of heart rate variability and Q-T dispersion can enhance the preditive value of malignant ventricular aarrhythmia and the results of thrombolysis therapy as there is certain correlation between these two parameters. The occurrence of malignant ventricular arrhythmia and the sudden death in AMI cases may be correlated with the decline of heart rate variability (SDNN and RMSSD) besides the increasing of Q-T dispersions.