急性ST段抬高型心肌梗死患者跨壁复极离散度变化及与室性心律失常的关系  

The Relationship of Transmural Dispersion of Repolarization and Ventricular Arrhythmia in Patients of Acute Myocardial Infarction with ST-Segment Elevation

作　　者：杨琦[1,2] 吴尚勤[2] 姚青海[2] 

机构地区：[1]天津医科大学,300070 [2]天津市胸科医院心内科

出　　处：《天津医药》2011年第2期130-132,共3页Tianjin Medical Journal

摘　　要：目的:探讨急性ST段抬高的心肌梗死患者心室跨壁复极离散度(TDR)的变化和室性心律失常及自主神经功能障碍的关系。方法:急性ST段抬高急性心肌梗死(AMI)且未能接受成功血管再通治疗的患者129例(STEMI组)和正常对照36例(对照组)作为研究对象。比较2组以及STEMI组入院即刻、第2天、第3天校正的跨壁复极离散度值(TDRc);分析STEMI组24h窦性心搏RR间期的标准差(SDNN)值和入院即刻TDRc的相关性;将STEMI患者分为恶性室性心律失常(MVA)组和非MVA组,比较2组入院即刻的TDRc值。结果:(1)STEMI组的TDRc大于正常对照组(P<0.01),而STEMI组上述3个时段的TDRc值差异无统计学意义(P>0.05)。(2)STEMI组TDRc值和SDNN呈负相关(r=-0.258,P<0.05)。(3)MVA组TDRc显著大于非MVA组(P<0.01)。(4)2例AMI患者住院期间死于心室纤颤,且均发生于MVA组。结论:自主神经功能失调参与了ST段抬高的AMI患者跨壁复极离散度扩增的形成。Objective： To study the relationship of transmural dispersion of repolarization （TDR） and the ventricular arrhythmia or automatic nerve system dysfunction in patients of acute myocardial infarction （AMI） with ST segment elevation （STE）.Methods： One hundred and twenty-nine STE-AMI patients,who were not capable being revascularized （AMI group） and 36 cases of control （control group） were enrolled randomly.The values corrected TDR were compared at the time point of in-charged,the 2nd day and the 3th day between AMI and control groups.The correlation of the SDNN value and TDRc at immediate admission was analysed in AMI group.Patients in AMI group were divided into malignant ventricular arrhythmia （MVA） group and non-MVA group according to Holter outcomes.The value of TDRc at immediate admission was prepared.Results： （1） TDRc was significantly higher in AMI group than that of control group （P 〈 0.01）,whereas there was no significantly difference in the value of the TDRc at different time-points in AMI group （P 〉 0.05）.（2） There was a significant negative correlation between the value of TDRc and SDNN in AMI group （r = -0.258,P 〈 0.05）.（3） The value of TDRc was significantly higher in MVA group than that in non-MVA group （P 〈 0.01）.（4） There were 2 cases of 129 AMI patients that died of ventricular fibrillation in MVA group.Conclusion：The automatic nerve system may contribute to the enlargement of TDR of non-AMI patients.

关 键 词：心肌梗死 急性病 心电描记术 心律失常 心性 跨壁复极离散度 

分 类 号：R541.7[医药卫生—心血管疾病]