【摘要】 目的:观察急性心肌梗死(AMI)后梗死相关血管早期再灌注对QTc离散度(QTcd)的影响。方法:选择发病至直接PTCA+Stent治疗12小时以内的AMI患者42例,按照PTCA+Stent治疗是否成功分为再通组30例,无再通组12例。以同期胸痛、胸闷住院,经冠脉造影检查正常者30例作为对照组。术前术后做12导联心电图,测定其QTcd值,进行比较。结果:(1)AMI患者QTcd治疗前与对照组比较差异有极显著性(P<0.01)。(2)AMI组前、下壁梗死之间QTcd无显著性差异。(3)FTCA+Stent治疗成功后(前向血流均达TIMI Ⅲ级,残余狭窄<30％)QTcd明显缩短,从(87.5±19.7)ms降至(58.7±20.6)ms(P<0.01)。未再通组QTcd仍保持高水平。(4)8例AMI患者治疗前有恶性心律失常,其QTcd明显长于无心律失常者(P<0.05),其中6例PTCA+Stent治疗成功后QTcd明显缩短,室性心律失常消失。结论:AMI直接PTCA+Stent术再灌注成功,缩短QTcd,减少恶性心律失常发生。更多还原

【Abstract】 To observe the effects of early reperfusion of infarct-related artery (IRA) on QTc dispersion (QTcd). Methods: Forty-two patients with acute myocardial infarction (AMI) managed with direct PTCA+ stent within 12 hours were divide into reperfusion group (n= 30) and non-reperfusion group (n= 12) , and 30 normal coronary angiogrph subjects were used as control. Before and after PTCA+ stent, QTcd was measured and compared. Results: (1)Compared with the control group, QTcd was significantly prolonged in patients with AMI before PTCA+ stent (P<0.01).(2) There was no significant difference in QTcd between anterior and inferior AMI. (3)After PTCA+ stent(forward flow;TIMI III grade, residual stenosis< 30 %), the QTcd in reperfusion group significantly decreased from 87.5 + 19.7 ms to 58.7 + 20.6 ms( P <0.01),while the QTcd in non-reperfusion group remained unchanged. (4)Eight patients with AMI were associated with malignant ventricular arrhythmias, and their QTcds were significantly longer than those in patients without arrhythmias (P <0.05) .among which the QTcds significant reduced and the ventricular arrhythmias disappeared in 6 patients after PTCA + stent. Conclusion: The early reperfusion of IRA after successfully direct PTCA + stent will cause the reduction of QTcd and the decrease of malignant ventricular arrhythmias in patients with AMI.更多还原