Morris S T, Galiatsou E, Stewart G A, Rodger R S, Jardine A G
The Renal Unit and Department of Medicine and Therapeutics, Western Infirmary, Glasgow, Scotland, United Kingdom.
J Am Soc Nephrol. 1999 Jan;10(1):160-3. doi: 10.1681/ASN.V101160.
Sudden cardiac death is common in patients on hemodialysis, and may occur in the immediate postdialysis period, when ventricular premature complexes are common. Elevated QT dispersion (Maximum - Minimum QT interval on standard 12-lead electrocardiogram) is associated with increased risk of ventricular arrhythmias following myocardial infarction, but has not previously been assessed in patients with chronic renal failure. We studied electrocardiograms recorded in 50 patients before and after a single hemodialysis session, and in 20 control subjects. QT dispersion was significantly higher in patients (63.1 +/- 20.6 ms) compared with control subjects (36.0 +/- 13.7 ms; P < 0.001) and rose significantly after hemodialysis to levels comparable to those seen following myocardial infarction (76.6 +/- 27.0 ms; P < 0.01). Because QT dispersion reflects nonhomogeneous recovery of ventricular excitability, hemodialysis patients may be at significantly greater risk of reentrant arrhythmias and sudden death in the postdialysis period.
心脏性猝死在血液透析患者中很常见，且可能发生在透析刚结束后的时间段，此时室性早搏很常见。QT离散度（标准12导联心电图上的最大QT间期减去最小QT间期）与心肌梗死后室性心律失常风险增加相关，但此前尚未在慢性肾衰竭患者中进行评估。我们研究了50例患者单次血液透析治疗前后以及20例对照者记录的心电图。与对照者（36.0±13.7毫秒；P<0.001）相比，患者的QT离散度显著更高（63.1±20.6毫秒），且血液透析后显著升高至与心肌梗死后相当的水平（76.6±27.0毫秒；P<0.01）。由于QT离散度反映心室兴奋性恢复的不均一性，血液透析患者在透析后阶段发生折返性心律失常和猝死的风险可能显著更高。
