心梗后QT离散度的意义及美托洛尔的影响  

The significance of QT dispersion after myocardial infarction and the influence of meto-prolot

作　　者：刘燕[1] 李淑莲[2] 张骥[1] 宋秀珍[1] 郭锦萍[1] 袁贵华 

机构地区：[1]北京丰台医院,100071 [2]北京南苑医院

出　　处：《实用心脑肺血管病杂志》2001年第3期136-139,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的　观察心肌梗死 QT离散度 (QTd)对合并室速、室颤 (vt、vf)及近远期预后的临床意义及美托洛尔对心梗患者 QTd及心脏事件 (再发心梗、心衰、室速室颤猝死 )发生的影响。　方法　 10 6例急性心梗患者 (AMI)和 10 0例健康人对照作进行 QTd测定 ,对 AMI存活患者中的 5 0例给予美托洛尔治疗 ,并以未用美托洛尔的常规治疗者作为对照 ,观察 QTd变化及心脏事件发生率 ,随访期最多 5年(平均 4.40± 1.45年 )。　结果　 (1) AMI患者 QTd显著高于健康人 (P<0 .0 0 1) ;大面积心梗组 QTd显著高于单一部位心梗组 (P<0 .0 5 ) ;(2 ) AMI合并 vt、vf组 QTd显著高于不合并 vt、vf组 (P<0 .0 0 1) ,凡 QTd≥ 80 ms者其 vf发生率明显高于小于 80 m s者 (P<0 .0 1) ;(3)心梗患者远期发生猝死者其 AMI后 4周时的 QTd都≥ 6 0 m s,且均值显著高于存活者 (P<0 .0 0 1) ;(4 )经美托洛尔治疗后 QTd明显缩短 ,心脏事件发生率明显低于不用美托洛尔 (常规 )组 (P<0 .0 1)。　结论　 QTd对预测 AMI预后及 vt、vf发生率有一定价值 ,4周后 QTd仍增高可能与远期猝死率有关 ;AMI后出院患者用美托洛尔治疗可使QTd正常化加快 ,有利于防止和减低心脏事件的发生 ,降低心梗患者的远期猝死率。Objective To investigate the clinical significance of QT dispersion(QTd) after acute myocardial infarction(AMI),and observe the influence that the patients with AMI were treated by using metoprolol. Methods 106 acute cardiac muscle infarction(AMI) patients and 100 normal people were measured QTd.50 survivals treated by using metoprolol and compared the patients who treated with traditional methods.The change of QTd and the frequency of cardiac accident etc.Were traced for a period of 5 years(average 4.40±1.45 years). Results (1)QTd for AMI of patients are significantly higher than normal group(P<0.001);QTd for extensive myocardial infarction are significantly higher than limited myocardial infarction group;(2)QTd for AMI incorporated with ventricular tachycardia or ventricular fibrillation group are significantly higher than the group without ventricular tachycardia or ventricular fibrillation.The frequency for QTd≥80ms is significantly higher than that of QTd<80ms(P<0.01);(3)QTd(all≥60ms) after 4 weeks for AMI patients who died in long period are significantly more than those survivals(P<0.001);(4)QTd is greatly shortened after treatment of metoprolol.The frequency of cardiac accident is significantly fewer than the group without using metoprolol (P<0.01). Conclusion The investigation shows that QTd is valuable for predicting AMI consequences and vt,vf frequency.The increasing QTd after 4 weeks may be related with cardiac sudden death.Treatment of metoprolol can decrease QTd,and prevent or decrease the occurance of cardiac accident and cardiac sudden death frequency in long term.

关 键 词：心肌梗死 QT离散度 猝死 美托洛尔 心脏事件 

分 类 号：R542.220.5[医药卫生—心血管疾病]