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急性心肌梗死患者的QT离散度

[QT dispersion in patients with acute myocardial infarction].

作者信息

Bancarz A, Kobusiak-Prokopowicz M

机构信息

Katedry i Kliniki Kardiologii Akademii Medycznej we Wrocławiu.

出版信息

Pol Merkur Lekarski. 1998 Sep;5(27):120-3.

Abstract

The aim of the study was the evaluation of the QT dispersion interval in patients with acute myocardial infarction, taking into consideration its location, treatment provided and coronary artery reperfusion. Investigations were performed in 75 patients treated because of acute myocardial infarction, including 57 men and 18 women, age 40-84 years. Acute myocardial infarction was recognised on a base of generally accepted criteria. At the reception standard 12-outputs ECG was performed. Next ECG testing was performed after 3 hours from the start of the thrombolytic therapy. In case of patients which were not qualified for thrombolytic therapy next ECG was applied within 3 hours after reception. For further observation of changes in QT dispersion ECG generally provided within 2, 3, 4 and 5 day of hospitalization were used. Taking as a location criterium of infarction the method of provided treatment and obtained reperfusion in the infarcted area, patients were classified to the one of 6 groups. To the first group (I)-patients with inferior wall infarction, treated thrombolytically with obtained reperfusion-15 patients were included, age 41-69 years. To the second group (II)-patients with inferior wall infarction, treated thrombolytically without obtained reperfusion-18 persons were included, age 43-84 years. To the third group (III)-patients with inferior wall infarction, not treated thrombolytically-9 patients were included, age 49-72 years. To the fourth group (IV)-patients with anterior wall infarction, treated thrombolytically with obtained reperfusion-9 persons were included, age 40-73 years. To the fifth group (V)-patients with anterior wall infarction, treated thrombolytically without obtained reperfusion-10 persons were included, age 47-78 years. To the sixth group (VI)-patients with anterior wall infarction, not treated thrombolytically-14 patients were included, age 44-81 years. Control group for the comparison of initial evaluation of the QT and QTc dispersion interval was group of 11 healthy persons, age 27-64 years. There was proved, that in patients with acute myocardial infarction, independently of its location, QT and QTc dispersion was increased. Thrombolytic therapy in patients with acute inferior wall myocardial infarction with reperfusion obtained causes extension of QT dispersion. In patients with acute anterior wall myocardial infarction thrombolytic therapy with obtained reperfusion causes reduction of QT and QTc dispersion. In patients not treated thrombolytically, which had anterior wall myocardial infarction, in first days of observation QT and QTc dispersion was increased. This effect was not observed in patients with inferior wall infarction.

摘要

本研究的目的是评估急性心肌梗死患者的QT离散间期,同时考虑其梗死部位、所接受的治疗及冠状动脉再灌注情况。对75例因急性心肌梗死接受治疗的患者进行了调查,其中包括57名男性和18名女性,年龄在40 - 84岁之间。急性心肌梗死依据普遍认可的标准进行诊断。入院时进行标准的12导联心电图检查。在溶栓治疗开始3小时后进行下一次心电图检测。对于不符合溶栓治疗条件的患者,在入院后3小时内进行下一次心电图检查。为进一步观察QT离散度的变化,使用了患者住院第2、3、4和5天常规进行的心电图检查。根据梗死部位、所采用的治疗方法及梗死区域获得的再灌注情况作为梗死定位标准,将患者分为6组。第一组(I)为下壁梗死患者,接受溶栓治疗且实现再灌注,共纳入15例患者,年龄41 - 69岁。第二组(II)为下壁梗死患者,接受溶栓治疗但未实现再灌注,共纳入18例患者,年龄43 - 84岁。第三组(III)为下壁梗死患者,未接受溶栓治疗,共纳入9例患者,年龄49 - 72岁。第四组(IV)为前壁梗死患者,接受溶栓治疗且实现再灌注,共纳入9例患者,年龄40 - 73岁。第五组(V)为前壁梗死患者,接受溶栓治疗但未实现再灌注,共纳入10例患者,年龄47 - 78岁。第六组(VI)为前壁梗死患者,未接受溶栓治疗,共纳入14例患者,年龄44 - 81岁。用于比较QT和QTc离散间期初始评估的对照组为11名健康人,年龄27 - 64岁。结果证实,在急性心肌梗死患者中,无论梗死部位如何,QT和QTc离散度均增加。急性下壁心肌梗死患者接受溶栓治疗并实现再灌注会导致QT离散度延长。急性前壁心肌梗死患者接受溶栓治疗并实现再灌注会导致QT和QTc离散度降低。未接受溶栓治疗的前壁心肌梗死患者在观察的最初几天内QT和QTc离散度增加。而下壁梗死患者未观察到这种效应。

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