急性ST段抬高心肌梗死直接PCI干预时间对QT离散度的影响

Influence of primary PCI time on QT dispersion in patients with acute ST-segment elevation myocardial infarction

目的:探讨急性ST段抬高型心肌梗死(STEMI)患者的症状发作至球囊扩张时间(SOTBT)对QT离散度(QTd)的影响。方法:收集82例急性STEMI行直接PCI治疗患者,根据SOTBT分为<3h组、3~6h组、>6h组,测量各组PCI术前、术后24h、术后72h心电图QTd及心率校正QT间期离散度(QTcd),比较各组间QTd及QTcd的变化差异。结果:PCI术前,SOTBT<3h组的QTd及QTcd较SOTBT 3~6h组和SOTBT>6h组明显延长(P<0.05或P<0.01);3组PCI术后24h及72h的QTd、QTcd均较术前显著缩短(P<0.05或P<0.01);术后24h,随着SOTBT的延长,QTd及QTcd缩短值逐渐下降,SOTBT<3h组的变化最大,QTd缩短值为(32.5±11.2)ms,QTd平均缩短率为43.6%,QTcd缩短值为(35.5±11.8)ms,QTcd平均缩短率为44.6%,分别与其他2组相比均差异有统计学意义(P<0.01);术后72hQTd及QTcd在术后24h的基础上有进一步下降,但变化在各组并不显著。结论:直接PCI治疗能显著缩短急性STEMI患者的QTd,与SOTBT 3~6h组和>6h组相比,SOTBT<3h组QTd缩短更显著,且在PCI术后的最初24h缩短幅度最大,表明急诊PCI患者SOTBT越短,疗效更佳。

Objective：To investigate the influence of symptom-onset-to balloon time （SOTBT） on QT disper sion （QTd） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Method： Eight -two pa- tients with acute STEM/ received primaryPC1 were divided into 3 groups （〈3 h,3～6 h,〉6 h） according to SOTBT. QTd and QTed were measured before PCI,24 hours and 72 hours after PCI respectively from the ECG, and the comparisons were carried out between the groups. Result： Before PC1, QTd and QTcd were significantly longer in SOTBT〈3 h group than SOTBT 3～6 h and SOTBT〉6 h groups （P〈0.05 or P〈0. 01）. QTd and QTcd in the three groups were significantly reduced both 24 hours and 72 hours after PCI than that before PCI （P d0.05 or P〈0.01）. 24 hours after PCl,with the extension of SOTBT,the absolute QTd and QTcd reduction de- creased. The maximum absolute QTd reduction （32. 5 ±11. 2） ms, maximum mean relative QTd reduction rate （43.6%）,maximum absolute QTcd reduction （35.5±11.8） ms and maximum mean relative QTcd reduction rate （44.6%） were round in the group of SOTBT〈.3 h compared with groups of SOTBT 3～6 h and SOTBT〉6 h（P d0.01）. Seventy two hours after PCI,QTd and QTcd went a further reduction on the basis of 24 hours after PCI, but the changes were not significant among the groups. Conclusion： Primary PCI is an effective method to shorten the QTd in patients with acute STEMI, and the maximum absolute QTd reduction was found in SOTBT〈3 h group, which shows that the shorter SOTBT of emergency PCI, the better curative effect for patients.