再灌注治疗后心肌灌注状态对心电图QT离散度的影响

Influence of myocardial microcirculatory reperfusion on QT interval dispersion after successful reperfusion therapy

目的 探讨急性心肌梗死 (AMI)再灌注治疗后心肌微循环灌注状态与心电图QT离散度 (QTd)和临床预后的关系。方法 经静脉溶栓和经皮冠状动脉腔内球囊成形术 (PTCA)再灌注治疗成功的AMI患者 30 8例 ,再灌注治疗后 1h按照 12导联心电图ST段的下移幅度分为A和B两组。A组为ST段迅速下降组 (下降≥ 5 0 % ) ,共 2 2 1例 ;B组为ST段持续抬高组 (下降 <5 0 % ) ,共 87例。分别计算两组患者入院即刻、再灌注治疗后 1h和 2 4h心电图的QTd ,并进行比较。结果 A组患者CK、CK MB峰值均明显小于B组 (P <0 0 5 ) ,分别为 (315 5± 2 0 4 6 )vs(4 2 5 3± 2 76 2 ) ;(12 9± 80 )vs(181± 94 )。A组左心室射血分数明显高于B组 (5 7%vs 4 7% ,P <0 0 5 ) ,左心功能不全、梗死后心绞痛发生率均明显低于B组 (P <0 0 5 ,7 5 %vs10 4 % ;4 6 %vs 8 3% )。A组再灌注治疗后 1h、2 4h心电图QTd均明显低于B组 (P <0 0 5 ) ,分别为 (4 0± 14 )vs(4 6± 12 ) ;(37± 13)vs(4 5± 15 )。结论 AMI再灌注治疗后 ,心肌组织水平灌注状态与临床预后及QTd有相关性 ,QTd和心电图ST段回落速度是判断心肌微循环灌注状态的简易实用指标。

Objective To investigate the relationship between the extent of myocardial microcirculation reperfusion and clinical outcome and QT interval dispersion Methods In 308 patients with acute myocardial infarction (AMI) who underwent successful thrombolytic therapy or primary angioplasty ECG ST segment recovery and QT interval dispersion were measured at admission and 1 and 24 hours after reperfusion Results In 221 out of 308 patients ST segment rapidly recovered ≥50% (group A) and in 87 it recovered <50% (group B) one hour after reperfusion, plasma CK, CK MB peak and incidence of post myocardial infarction agina pectoris were significantly lower in group A than in group B; Left ventricular ejection function significantly was higher in group A than in group B As well as QT interval dispersion was significantly lower in group A than in group B one hour and 24 hours after reperfusion Conclusion Patients who had received successful reperfusion therapy after AMI with rapid ST segment recovery ≥50% had limited infarct size, better left ventricular function, smaller QT interval dispersion QT interval dispersion and ST segment recovery may provide additional information about the degree of reperfusion at microcirculation level achieved in patients with a patent epicardial infarct related artery after thrombolytic therapy or primary angioplasty