Tp-e间期和Tp-e/QT比值对急性脑外伤患者预后的预测  

Prognostic value of Tp-e and Tp-e/QT ratio in patients with acute brain injury

作　　者：赵香梅[1] 秦历杰[1] 李法良[1] 杨先芝[1] 李琳[1] 杨蕾[1] 陈龙 Zhao Xiangmei;Qin Lijie;Li Faliang;Yang Xianzhi;Li Lin;Yang Lei;Chen Long(Emergency Department of Henan Provincial People's Hospital and People's Hospital of Zhengzhou University,Zhengzhou,450003,China)

机构地区：[1]河南省人民医院,郑州450003

出　　处：《中华急诊医学杂志》2020年第2期253-256,共4页Chinese Journal of Emergency Medicine

基　　金：河南省科技攻关项目(142102310417)。

摘　　要：目的本研究探讨急性脑外伤患者心电图相关指标的变化及其与预后的关系。方法前瞻性收集2014年1月至2018年1月就诊的急诊脑外伤患者289例,最终入选219例及与相匹配的对照组220例,入院1 h及住院72h行心电图,测算P波离散度(Pd)、校正后QT(QTc)、校正后QT离散度(QTcd)、校正后Tp-e间期(Tp-ec)、校正后Tp-e间期离散度(Tp-ecd)及Tp-e/QT比值,分别应用独立样本t检验和配对样本r检验比较脑外伤组第1天和对照组、第1天和第3天上述指标的变化,分析外伤组心电图指标与病情轻重及住院期间不良事件(MACE)的关系。结果脑外伤组患者第3天QTc、Tp-ec和Tp-e/QT较对照组及第1天均增加,差异有统计学意义(P均<0.05);格拉斯哥(GCS)评分中重度脑损伤患者Tp-ec、Tp-e/QT较评分为轻度者增大,差异有统计学意义[(150.48±16.58)vs(130.14±11.86),P=0.006;(0.29±0.04)vs(0.23±0.03),P=0.030]。住院期间出现MACE组患者Tp-ec,Tp-e/QT较无MACE组增大[(149.76±12.52)vs(128.84±12.47),P<0.001;(0.30±0.04)vs(0.21±0.03),P<0.001]。结论急性脑外伤患者Tp-e和Tp-e/QT与病情严重程度相关,一定条件下可作为短期预后的评价和预测指标。Objective This study aimed to investigate the changes of ventricular repolarization index on ECG and its relationship between prognosis in patients with acute cerebral trauma.Methods From January 2014 to January 2018,data of 289 consecutive patients with emergency traumatic brain injuries were prospectively collected and ultimately 219 cases were selected into the study group.Meanwhile,220 healthy persons matched by age and sex served as the control group.ECG indexes such as P wave dispersion(Pd),corrected QT(QTc),Tp-e and Tp-e/QT were all measured and calculated in the 1st and 72th hour.The independent sample t test and paired t test were used to compare the changes of the above indexes on the 1st day and the control group,the 1st day and the 3rd day,respectively,and the association between ECG indexes and the illness severity or adverse events(MACE)of the trauma group during hospitalization.Results QTc,Tpec and Tp-e/QT of the acute cerebral trauma group increased on the 3rd day compared with the control group and on the first day,the differences were statistically significant(P all<0.05).Tp-ec and Tp-e/QT in patients with moderate to severe brain injury in Glasgow Coma Scale(GCS)were increased,and the differences were statistically significant(150.48±16.58 vs 130.14±11.86,P=0.006).(0.29±0.04 vs 0.23±0.03,P=0.030).Tpec and Tp-e/QT were significantly increased in acute brain truma patients with MACE during hospitalization compared with those without MACE(149.76±12.52 vs 128.84±12.47,P<0.001).(0.30±0.04 vs 0.21±0.03,<0.001).Conclusion Tp-e and Tp-e/QT in patients with acute cerebral trauma are correlated to the severity of the disease,which could be used as short-term prognostic indicators under certain conditions.

关 键 词：急性脑外伤 心电图 TP-E间期 Tp-e/QT比值 预后 

分 类 号：R651.15[医药卫生—外科学]