老年陈旧性心肌梗塞运动试验后Q-Tc离散度的临床意义  

Clinical significance of Q Tc dispersion after exercise in aged patients with old myocardial infarction

作　　者：余国龙 庄汉屏 何劲 李兢 陈干仁 曹小元 

出　　处：《湖南医科大学学报》1999年第3期248-250,共3页Bulletin of Hunan Medical University

摘　　要：目的：评价运动试验后ＱＴｃ离散度（ＱＴｃｄ）在老年陈旧性心肌梗塞中的临床意义。方法：对６４例老年陈旧性心肌梗塞患者（心梗组）进行活动平板运动试验、２４ｈ动态心电图、超声心动图检测及临床随访平均２４１２±７７月；并以３０例健康老年人为对照组。结果：心梗组运动试验前为ＱＴｃｄ（４０２１±１５２１）ｍｓ，运动试验后为（５９３７±２０１７）ｍｓ（Ｐ＜０．０１）；对照组ＱＴｃｄ运动试验前、后比较差异均无显著性（Ｐ＞０．０５）；两组ＱＴｃｄ运动试验前比较差异无显著性（Ｐ＞０．０５），但运动试验后心梗组ＱＴｃｄ较对照组明显增高（Ｐ＜０．０１）。运动试验后心梗组ＱＴｃｄ＞５０ｍｓ异常者室壁节段性运动异常、室壁瘤、心功能级别Ⅲ级和Ｌｏｗｎ氏室性心律失常等级Ⅲ级以上的发生率均显著性高于ＱＴｃｄ＜５０ｍｓ正常组。随访期间心梗组中，ＱＴｃｄ异常者发生心脏性猝死５例，而正常者未发生心脏性猝死。结论：运动试验后ＱＴｃｄ是预测陈旧性心肌梗塞室性心律失常及心性猝死重要指标之一。Objective: This study was aimed to evaluate clinical significance of Q Tc dispersion after exercise in aged patients with old myocardial infarction. Method: Sixty four aged patients with old myocardial infarction(infarction group) were examined by treadmill exercise, dynamic electrocardiography, echocardiography, and were followed up for average of 24.12±7.7 months. 30 healthy aged persons were served as control group. Results: Compared with that (40.21±15.21ms) before exercise, Q Tc dispersion (59.37±20.17ms) was increased significantly after exercise in infarction group( P <0.01). But no significant difference was found in Q Tc dispersion of control group before and after exercise(34.70±12.29ms vs 38.91±13.62ms P >0.05). In infarction group, occurrence of abnormal contraction of left ventricular wall, aneurysms, NYHA Ⅲ class and >Ⅲ class of Lown's ventricular arrhythmia classification was significantly higher in Q Tcd>50ms patients than that in Q Tcd<50ms ones( P <0.05). It was found that 5 patients died of cardiac sudden death in Q Tcd>50ms patients and no one died of cardiac sudden death in Q Tcd<50ms ones. Conclusion: The Q Tc dispersion after exeroise is an important index to predict ventricular arrhythmia and cardiac death in the patients with old myocardial infarction.

关 键 词：陈旧性 心肌梗塞 QT离散度 老年人 

分 类 号：R542.22[医药卫生—心血管疾病] R540.4[医药卫生—内科学]