急性心肌梗死早期溶栓治疗效果与QT间期离散度的关系

The Effects of Early Thrombolytic Therapy on QT Interval Dispersion in Patients with Acute Myocardial Infarction

【目的】探讨急性心肌梗死早期溶栓治疗效果与QT间期离散度 (QTd)的关系。【方法】 2 2 6例急性心肌梗死患者分为 :溶栓成功组 (6 3例 ) ;溶栓失败组 (5 2例 ) ;非溶栓组 (111例 )。所有研究对象分别在入院当时 (平均 7 1h± 1 6h) ,发病后第 2天、第 1周末及第 2周末记录标准 12导联心电图。QT间期的测量从QRS波起点至T波终点 ,同一导联测量 3个心动周期 ,取其平均值。不同导联最大QT值减去最小QT值为QTd值。【结果】 3组QTd入院当时无差异 (P >0 0 5 ) ,但起病后第 2日、第 1周末及第 2周末溶栓成功组QTd[分别为 (4 8± 17)ms,(4 3± 15 )ms,(36± 14)ms]较溶栓失败组 [分别为 (6 5± 18)ms ,(5 5± 16 )ms,(4 7± 15 )ms]和非溶栓组 [分别为 (6 7± 16 )ms ,(5 4± 14)ms,(4 9± 13)ms]小 ,P <0 0 1;后 2组比较 ,P >0 0 5。【结论】急性心肌梗死成功的早期溶栓治疗能使QTd值减小 ,提示急性心肌梗死早期梗死相关冠状动脉再通能提高心肌电稳定性。

Objective To assess the effects of early thrombolytic therapy on QT interval dispersion (QTd) in patients with acute myocardial infarction (AMI). Methods Two hundreds and twenty-six patients with a first Q wave AMI who fit the criteria of QTd measurement were divided into three groups: the successful thrombolytic therapy group (n=63), the unsuccessful thrombolytic therapy group (n=52) and the non- thrombolytic therapy group (n=111). For the measurement of QTd, 12- lead ECG was recorded in all patients at the time of admitted to hospital (mean 7.1 h ± 1.6 h), on the second day, at the end of one week and two weeks after onset of AMI. QTd is referred to the value between maximum QT and minimum QT in different leads in the same ECG. Results At the time of admitted to hospital, the values of QTd were not significantly different among the three groups. On the second day, at the end of one week and two weeks, the values of QTd were significantly lower in the successful thrombolytic therapy group [(48±17) ms,(43±15) ms,(36±14) ms, respectively] as compared with the unsuccessful thrombolytic therapy group [(65±18) ms,(55±16) ms,(47±15) ms, respectively] and the non-thrombolytic therapy group [(67±16) ms,(54±14) ms,(49±13) ms, respectively](P<0.01), but there was no different between the later two groups. Conclusion Early successful thrombolytic therapy can decrease QTd in patients with AMI, suggesting that early revascularization of infarct related artery for AMI improves myocardial electrical stability.