摘要
目的观察２７例急性心肌梗塞（ＡＭＩ）患者梗塞相关血管（ＩＲＡ）早期再灌注对ＱＴｃ离散度（ＱＴｃｄ）的影响。方法对２７例ＡＭＩ予以静脉溶栓，于溶栓后９０分钟进行选择性冠状动脉造影，在溶栓前后作同步记录１２导联心电图测量ＱＴｃｄ，并与４３例冠状动脉造影正常者进行对照。结果ＡＭＩ组溶栓前与对照组间ＱＴｃｄ差异有极显著性（８６６±１２２ｍｓｖｓ３５．８±１６７ｍｓ，Ｐ＜０００１），前壁与下壁梗塞之间ＱＴ离散度差异无显著性。静脉溶栓后９０分钟冠脉造影显示ＩＲＡ血流达到ＴＩＭＩＩ～ＩＩ者，溶栓后２小时ＱＴｃｄ显著降低（８７２±１２８ｍｓｖｓ５９．５±１３６ｍｓ），而ＩＲＡ未开通者其ＱＴｃｄ在溶栓前后始终保持较高水平，恢复速度显著慢于开通组。６例溶栓前有恶性室性心律失常者其ＱＴｃｄ明显高于无伴心律失常者（９４８±９２ｍｓｖｓ８４．２±１２０ｍｓ，Ｐ＜００５），溶栓后其ＩＲＡ血流均达ＴＩＭＩＩＩ级，ＱＴｃｄ降至６８３±８８ｍｓ，室性心律失常消失。结论成功地溶栓再灌注可使ＱＴｃｄ显著降低，改变其自然演变过程。ＩＲＡ早期再灌注，可减少危险性心律失常的发生。
Objective To evaluate the effects of early reperfusion of infarct related artery (IRA) after intravenous thrombolysis on QTc dispersion (QTcd).Methods 27 acute myocardial infarction (AMI) patients and 43 normal coronary artery subjects used as control were studied. Coronary artery angiograpy was done at 90th minute after intravenous thrombolysis therapy in AMI patients, and QTcd was measured before and after thrombolysis. Results QTcd was significantly prolonged in patients with AMI before thrombolysis compared with control group. There was no significant difference in QTcd between anterior AMI and inferior AMI. At 2nd hour after intravenous thrombolysis QTcd decreased significantly ( P <0 001) in TIMI II III grade group (from 87.2±12 8ms to 59.5±13 6ms), and QTcd remained unchanged in TIMI 0 I grade. Six AMI patients were associated with malignant ventricular arrhythmias before thrombolysis, and the QTcd was significantly ( P <0 05) longer in these patients as compared with those patients without arrhythmia. After thrombolysis, all of the 6 patients achieved TIMI 3 grade flow of IRA, and were associated with a significant reduction of QTcd and disappearance of ventricular arrhythmias. Conclusions Successful early reperfusion of IRA is associated with the reduction of QTcd and the decreased risk of ventricular arrhythmia in AMI patients.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
1998年第5期374-375,共2页
Chinese Journal of Cardiology
关键词
QT离散度
心肌梗塞
AMI
溶栓疗法
QTc dispersion myocardial infarction thrombolytic therapy
