摘要
目的：通过急性心肌梗塞（AMI）溶栓治疗前后QT离散度（QTd）变化的研究，探讨溶栓后QTd变化与冠脉再通的关系．方法：顺序选择AMI国产尿激酶静脉溶栓的住院患者66例及冠状动脉造影（CAG）正常者30例，CAG判断溶栓效果，测量并比较溶栓前后及CAG正常者标准12导联ECG上的QTd．结果：溶性前再通组与未通组的QTd分别为（83．33±29．61）ms和（7．76±19．14）ms（P＝0．23），比对照组QTd（28．20±7．20）ms明显增高（P＜0.01）；再通组溶栓前与溶栓后1d，7d，1mo的QTd分别为（83．33±29．61）ms，（47．33±17．89）ms，（42．11±18．54）ms和（3．33±13．55）ms，说明溶栓后QTd明显降低（P＜0．01）．而未通组各时间点QTd降低不明显．再通组溶栓后24hQTd下降幅度最大，为（40．00±22．43）ms，未通组仅为（6．43±3．37）ms（P＜0．01）．与CAG对比，溶栓后24h内QTd下降≥20.00ms时冠脉再通的敏感性为82％，特异性91％，准确性85％，阳性预告值95％，阴性预告值70％．结论：AMI溶栓前QTd明显增高，成功溶栓后明显降低；溶栓后24h内QTd下降≥20．00ms，提示梗塞相关血管再通，认为它可作为AMI溶栓后冠脉再通的无创性指标之一．
Aim: To evaluate the relation of QTd reductionafter thrombolytic therapy in AMI to the patency ofinfarctrelated coronary artery. Methods: We study 66 patientswith AMI who were treated with urokinase within 6h aftersymptom onset and 30 persons with normal coronaryangiography. The coronary reperfusion status was determinedby the coronary angiography between 90～120 minutes afterthrombolysis. QTd before and after 1d, 7d, 1 mo. withthrombolytic therapy was measured and compared withthose of coronary angiography normal. Results: Similarresult (P=0. 23) was obtained to compare QTd (83. 33±29. 61 ) ms, (74. 67±19. 14) ms before thrombolytictherapy in reperfusion group and non-reperfusion group and therewas significant increase (P<0. 01) compared with normalgroup QTd (28. 20±7. 20) ms. There was significanttreduction in QTd (47. 33± 17. 89) ms, (42. 11±19. 54) ms,(37. 33±13. 55) ms, respectively (P<0. 01) in reperfusiongroup and no significant reduction in QTd in non-reperfusion group at 1d, 7d, 1mo after thrombolytic therapycompared with before thrombolytic therapy, QTd reduction was(40. 00±22. 43) ms within 24h after thrombolytic therapyin reperfusion group, that (6. 43± 3. 37) ms in non-reperfusion group (P<0. 01 ). When QTd reduction was ≥20 ms,within 24h after thrombolytic therapy comparing withCAG, predicts coronarp artery reper fusion with sensitivity0. 82, specificity 0. 91, acurran cy 0. 85, positive predictivevalue 0. 95, negative prodictive value 0. 70. Conclusion:The results of the study show that there is asignificantincrease in QTd before thrombolytic therapy with AMI, QTdis significant reduced with successful thrombolysis in postAMI patients. QTd reduction ≥20 ms within 24h afterthrombolytic therapy, might predict patency of infarct-re-related artery.
出处
《第四军医大学学报》
1998年第6期668-669,共2页
Journal of the Fourth Military Medical University
关键词
心肌梗塞
AMI
溶栓疗法
QT离散度
QT dispersion electrocardiography throm bolysis/intervein myocardial infarction/acute coronary angiography
