联合应用心律震荡与QT离散度对大面积急性心肌梗死患者心源性死亡的预测价值  

Predictive value of combined use of heart rate turbulence and QT dispersion on cardiac death in patients with massive acute myocardial infarction

作　　者：黄学成[1] 王琦武[1] 尚晓斌[1] 梁艺[1] 陈青萍[1] 

机构地区：[1]广西医科大学第三附属医院心血管内科,南宁530031

出　　处：《岭南心血管病杂志》2016年第1期16-18,共3页South China Journal of Cardiovascular Diseases

基　　金：南宁市科学技术局资助项目(项目编号:200802110C)

摘　　要：目的探讨联合应用心律震荡(heart rate turbulence,HRT)与QT离散度(QT dispersion,QTd)对大面积急性心肌梗死(acute myocardial infarction,AMI)患者心源性死亡的预测价值。方法入选165例大面积AMI患者,入院后进行24 h动态心电图检查,计算HRT震荡初始(turbulence onset,TO)和震荡斜率(turbulence slope,TS)的两个参数,并测量QTd水平。所有患者根据是否发生心源性死亡分为死亡组和生存组。规定12导心电图中病理性Q波导联数≥4为大面积梗死。结果死亡组TO≥0,TS≤2.5 ms/RR间期的阳性率高于生存组,差异有统计学意义(55.2%vs.15.4%,P<0.01)。死亡组QTd水平高于生存组,差异有统计学意义[(109.02±8.77)ms vs.(77.73±9.03)ms,P<0.01],且死亡组QTd水平均>100 ms。而联合应用TO≥0,TS≤2.5 ms/RR和QTd>100 ms作为预测早期大面积AMI患者死亡的检测指标,其阳性预测值、特异度分别为58%、91%,均分别高于QTd>100 ms和TO≥0且TS≤2.5ms/RR间期的32%、62%和43%、80%(P<0.01;P<0.05)。结论联合应用TO≥0,TS≤2.5ms/RR间期和QTd>100 ms时,可作为预测大面积AMI患者发生心源性死亡的敏感指标之一。Objectives To investigate the predictive value of combined use of heart rate turbulence （HRT） and QT dispersion （QTd） on cardiac death in patients with massive acute myocardial infarction （AMI）. Methods Totally 165 patients with massive AMI were examined by 24 h Holter monitoring. QTd, turbulence onset （TO） and turbulence slope （TS） of HRT were measured. All the patients were divided into death group and living group according to their occurrence of cardiac death. In the routine 12-leads electrocardiogram, pathological Q waves i〉4 were diagnosed as massive infarction. Results The positive rate in death group was significantly higher than that in living group at TO ≥ 0, TS ≤2.5 ms/RR interval （55.2% vs. 15.4%, P〈0.01 ）. QTd in death group was significantly higher than that in living group [ （109.02±8.77） ms vs. （77.73±9.03） ms, P〈0.01 ] and all QTd in death group was 〉100 ms. For measurements of predictor of death in patients with massive AMI, the positive rate and specificity of the combined use of TO≥0,TS≤ 2.5 ms/RR interval and QTd〉100 ms were 58% and 91% respectively, higher than QTd〉100 ms （32%, 62% respectively, P〈0.01） and TO≥0,TS≤2.5 ms/RR （43%, 80% respectively, P〈0.05）. Conclusions Combined use of TO≥0,TS≤2.5 ms/RR interval and QTd〉100 ms can be one of the sensitive targets in predicting cardiac death in patients with massive AMI.

关 键 词：大面积急性心肌梗死 心律震荡 QT离散度 联合应用 心源性死亡 

分 类 号：R542.22[医药卫生—心血管疾病] R541.7[医药卫生—内科学]