急性心肌梗死QT离散度的临床意义  

Clinical significance of QT dispersion in patients with acute myocardial infarction

作　　者：陈春安[1] 

机构地区：[1]湖北省潜江市江汉油田中心医院心内科,湖北潜江433124

出　　处：《第四军医大学学报》2002年第4期367-370,共4页Journal of the Fourth Military Medical University

摘　　要：目的　探讨急性心肌梗死 (AMI)患者 QT离散度(QTd)及校正心率后 QT离散度 (QTcd)的临床意义及与近期临床预后的关系 .方法　测量分析 92例 AMI患者的 QTd和 QTcd,其中男 62例 ,女 30例 ,年龄 42～ 80 (平均 54.3)岁 ,与 60例无心脏病者 QTd和 QTcd对照分析 ,其中男 39例 ,女2 1例 ,年龄 40～ 75(平均 52 )岁 .结果　 AMI入院时 QTd(66± 30 ) ms,QTcd(75± 36) ms明显高于对照组 (39± 1 6) ms,(42± 1 7) ms (P<0 .0 0 1 ) .死亡组 QTd(1 0 5± 2 5) ms,QTcd(1 2 2± 33) ms明显高于生存组 (54± 1 8) ms,(60± 2 0 ) ms(P<0 .0 0 1 ) .QTd≥ 80 ms患者死亡率 62 .5% ,多部位梗死56.3% ,室心律失常 53.1 % ,泵功能 (Killip分级 )≥ 级2 8.3% , - 度房室传导阻滞 1 2 .5%明显高于 QTd<80 ms的 3.3% ,2 5.0 % ,1 1 .7% (P<0 .0 1 ) ,6.7% ,5.0 % (P<0 .0 5) .生存患者出院时 QTd(45± 1 3) ms,QTcd(48± 1 4 )ms较入院时 (66± 30 ) ms(P <0 .0 1 ) ,(75± 36) ms(P<0 .0 5)明显缩小 .且最长的 QT间期 92 %见于缺血区或梗死区导联 ,而最短的 QT间期 95%见于非缺血区或非梗死区导联 .结论　临床上可通过 QTd及 QTcd测量来判断 AMI患者近期临床预后 .AIM To investigate the clinical significance of QT dispersion (QTd) and QT dispersion after correcting heart rate (QTcd) in patients with acute myocardial infarction (AMI), and the relationship to the recent clinical prognosis. METHODS QTd and QTcd in 92 cases of patients with AMI, whose ages were from 42 to 80 (54.3 on the average) years, were measured and analysed, among which, there were 62 male cases and 30 female, and we compared them with QTd and QTcd in 60 cases without heart diseases, whose ages were from 40 to 75 (52 on the average) years, in which, there were 39 male cases and 21 female ones. RESULTS QTd (66±30)ms and QTcd (75±36) ms of the patients with AMI admitted to hospital were apparently higher than QTd (39±16) ms and QTcd (42±17) ms of the control group ( P <0.001). QTd (105±25) ms and QTcd (122±33) ms of the death group were apparently higher than QTd (54± 18) ms and QTcd (60±20) ms of the living group ( P < 0.001). For the patients with AMI with Qtd≥80 ms, the death rate was 62.5%, the rate of multiple infarction 56.3%, the rate of ventricular arrhythmia 53.1%, pump function (killip classification ≥Ⅲ classes)28.3%, and the rate of Ⅱ ⅢO A V Block 12.5%, apparently higher than the rate in QTD<80 ms of the patients with AMI, which were 3.3%,25.0%,11.7% ( P <0.001), 6.7%, 5.0% ( P <0.05). QTd (45±13) ms, QTcd (48±14) ms of the living patients when discharged from hospital were apparently less than QTd (66± 30) ms ( P <0.01)and QTcd (75±36) ms ( P <0.05) of them when admitted to hospital. 92% of the Longest QT intervals appeared in the myocardial ischemia area or myocardial infarction area lead, yet 95% of the shortest QT intervals appeared in the non myocardial ischemia area or non myocardial infarction area lead. CONCLUSION Short term prognosis of AMI patients can be judged by the measurements of QTd and QTcd clinically.

关 键 词：心肌梗死 QT离散度 预后 心电描记术 

分 类 号：R542.22[医药卫生—心血管疾病]