摘要
目的：测定充血性心力衰竭（心衰）患者使用抗心律失常药物致心律失常作用时ＱＴ间期离散度的变化，探讨ＱＴ间期离散度能否作为抗心律失常药致心律失常作用的监测指标。方法：选择充血性心衰患者１８８例，分为单纯心衰组（９５例）和心衰并心律失常组（９３例）；另选健康对照组１０２例，均测ＱＴ间期离散度、左室射血分数（ＬＶＥＦ）及动态心电图。比较不同心功能组及抗心律失常药物治疗前后不同转归组的校正ＱＴ间期离散度（ＱＴｃｄ）值。结果：心衰并心律失常组ＱＴｃｄ值〔（８６．１６±２４．３３）ｍｓ〕高于单纯心衰组〔（６９．７６±１９．５１）ｍｓ〕，Ｐ＜０．０１。心衰ＬＶＥＦ＜０．４０组ＱＴｃｄ值〔（９０．２１±２８．４３）ｍｓ〕高于心衰ＬＶＥＦ＞０．４０组（７３．４５±２０．２６）ｍｓ，Ｐ＜０．０１。ＱＴｃｄ值与ＬＶＥＦ值呈中等程度负相关（ｒ＝－０．４２７，Ｐ＜０．０１）。治疗发生致心律失常作用组ＱＴｃｄ值〔（９９．８２±３０．４４）ｍｓ〕高于抗心律失常药物治疗前〔（８６．１６±２４．２３）ｍｓ，Ｐ＜０．０５〕和抗心律失常药物治疗好转组〔（５８．１１±１８．２２）ｍｓ，Ｐ＜０．０５〕，而与死亡组〔（１０２．８４±３２．５３）ｍｓ〕比?
Objective :To investigate changes in QT dispersion in proarrhythmia during use of antiarrhythmic drug in patients with congestive heart failure (CHF). Methods :QT dispersion,left ventricular ejection fraction(LVEF) and ambulatory ECG were determined in 188 patients with CHF,and they were divided into simple CHF group and CHF accompanied with arrhythmia group.In addition,102 healthy volunteers served as normal controls.Values of QT interval dispersion(QTcd) were compared in various groups in relation to heart function and before and after the use of antiarrhythmic drugs. Results :The value of QTcd in CHF accompanied with arrhythmia group was higher than simple CHF group (86162433)ms vs.(69761951)ms,P<001,and it was higher in CHF LVEF<040 group than LVEF>040 group (90212843)ms vs.(73452026)ms,P<001.The value of QTcd was correlated negatively with LVEF (r=-0427,P<001).The values of QTcd in patients developed proarrhythmia (99823044)ms were much higher than those prior to antiarrhythmic drug treatment (86162423)ms,P<005 or those with improvement during treatment (58111822)ms,P<005.However,there was no significant difference in the value of QTcd between patients who developed proarrhythmia and those with fatal outcome (P>005).In addition,the number of patients with proarrhythmia in CHF LVEF<040 group was significantly larger than CHF LVEF>040 group (16/92 vs.4/96.P<0001). Conclusions :In patients with CHF,proarrhythmia commonly occurred when antiarrhythmic drug is used,together with increase in QTcd value.The changes in QT dispersion is an important index in monitoring curative effect of antiarrhythmic drug and proarrhythmia.
出处
《中国危重病急救医学》
CSCD
1999年第7期427-427,共1页
Chinese Critical Care Medicine
关键词
心力衰竭
QT间期离散度
抗心律失常药物
治疗
congestive heart failure
QT dispersion
antiarrhythmic drug
proarrhythmia
