急性心肌梗死患者经皮冠脉介入治疗前后校正QT间期、校正Tp-e间期、Tp-e/QT的变化及其预测价值

摘要

目的 观察急性ST段抬高型心肌梗死(STEMI)患者成功行经皮冠脉介入治疗(PCI)术前术后校正QT间期、校正Tp-e间期、Tp-e/QT的变化,分析这些指标与恶性心律失常事件(MAE)的相关性,探讨其预测价值.方法 STEMI患者40例,12 h内成功行PCI术,分别测算术前及术后100 min梗死相关导联QTc、Tp-ec、Tp-e/QT,随访三个月后MAE情况.40例正常心电图做对照.结果 (1)STEMI组QTc、Tp-ec、Tp-e/QT在发病12 h内明显升高(P<0.05),PCI术后降低(P<0.05),但与对照组仍差异有统计学意义(P<0.05).(2) STEMI组以PCI术前QTc440ms为节点分组,随访三个月组间MAE发生差异无统计学意义(P>0.05);而以Tp-ec 100ms和 Tp-e/QT 0.25为节点,组间MAE发生有统计学意义.结论 急性STEMI患者Tp-ec,尤其是Tp-e/QT比值增加,与恶性心律失常事件相关,是预测急性STEMI后恶性心律失常事件的指标.%Objective To explore the changes of QT interval, Tp-e and Tp-e/QT ratio before and after percutaneous coronary intervention and their predictive value to the occurrence of malignant arrhythmia events in the patients with acute ST-segment elevation myocardial infarction. Methods Different indixes of corrected QT interval, corrected Tp-e and Tp-e/ QT ratio were measured and calculated by EGG respectively in 40 acute ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention. Results ( 1 ) QTc,Tp-ec and Tp-e/QT ratio in observation group prolonged significantly in 12 hours compared with control group ( P ＜ 0. 05 ) , and then reduced after percutaneous coronary intervention ( P ＜ 0. 05 ). ( 2 ) The occurrence of malignant arrhythmia e-vents had no significant difference between QTc interval joint points as 440 ms ( P ＞ 0. 05 ). And the occurrence of malignant arrhythmia events had a significantly difference( P ＜ 0. 05 ) when joint point of Tp-ec was 100ms and that of Tp-e/QT ratio was 0. 25 in 12 hours in observation group. Conclusion Tp-ec and Tp-e/QT ratio are possibly the indixes to predict malignant arrhythmia events in acute myocardial infarction patients.