急性心肌梗死溶栓治疗对QT离散度的影响及其意义

Effect on QT dispersion by successful thrombolytic therapy in acute myocardial infarction

目的 探讨溶栓治疗对急性心肌梗死 QT离散度的影响和意义 .方法 41例急性心肌梗死患者经溶栓治疗后分为溶栓再通组和溶栓未通组 ,分析溶栓前及溶栓后 12～ 2 4h,2～ 4d和 5～ 7d的 ECG,测算 QT,QTd,QTc和 QTcd.结果 溶栓治疗前、后 ,再通组和未通组之间 QT和 QTc差异均无显著性 ;溶栓再通组 ,溶栓治疗 12 h以后 QTd和QTcd均较溶栓前明显减小 ;溶栓未通组 ,溶栓后 5～ 7d QTd和 QTcd才明显减小 ;溶栓后的 1wk时间内 ,再通组 QTd和QTcd均较未通组明显减小 .结论 成功的溶栓能减小急性心肌梗死的 QTd,缩短 QTd减小所需的时间 .溶栓后 QTd减小可能反映了顿抑或晕厥心肌的“苏醒”

AIM To study the influence on QT dispersion by thrombolytic therapy in acute myocardial infarction patients. METHODS Fourty one patients with acute myocardial infarction receiving thrombolytic therapy were divided into reperfusion group and non reperfusion group according to the clinical characteristics. Electrocardiograms recorded were analyzed before thrombolysis and 12~24 h, 2~4 d and 5~7 d after thrombolysis, respectively. QT, QTd, QTc and QTcd were measured at each time period. RESULTS 1. QT and QTc did not change significantly both in the reperfusion group and in the non reperfusion group before and after thrombolytic therapy. 2. QTd and QTcd reduced significantly in the reperfusion group after 12 hours with thrombolytic therapy, yet QTd and QTcd did not reduce significantly in the non reperfusion group until 5~7 days after thrombolysis. 3. QTd and QTcd reduced more significantly in the reperfusion group than in the non reperfusion group at the same period. CONCLUSION Successful thrombolysis could notably reduce QTd in the patients with acute myocardial infarction in advance. The reduction in QTd after acute myocardial infarction might imply the revivals of stunned myocardium.