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急性ST段抬高型心肌梗死患者跨壁复极离散度变化及与室性心律失常的关系

杨琦,吴尚勤,姚青海   

  1. 天津市胸科医院
  • 收稿日期:2010-04-12 修回日期:2010-06-26 出版日期:2011-02-15 发布日期:2011-02-15
  • 通讯作者: 杨琦

Alteration of transmural dispersion of repolarization and its relationship to ventricular arrhythmia in patients with ST segment elevated acute myocardial infarction

  • Received:2010-04-12 Revised:2010-06-26 Published:2011-02-15 Online:2011-02-15

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摘要： [摘要] 目的 探讨急性ST段抬高的心肌梗死患者心室跨壁复极离散度（TDR）的变化和室性心律失常及自主神经功能障碍的关系。方法 入选急性ST段抬高AMI而未能接受成功的急诊血管再通治疗的患者129例和正常对照36例。比较上述2组以及AMI组入院即刻、第2天、第3天校正的跨壁复极离散度值（TDRc）；分析AMI组SDNN值和入院即刻TDRc的相关性；根据Holter结果将AMI患者分为恶性室性心律失常组（MVA组）和非MVA组，比较两组入院即刻的TDRc值。结果 （1）AMI组的TDRc显著大于正常对照组（P<0.001），而AMI组上述3个时段的TDRc值无显著差异（P>0.05）。（2）AMI组TDRc值和SDNN呈显著负相关（r=-0.258, P< 0.05）；（3）MVA组TDRc显著大于非MVA组（P<0.01）。（4）在观察的129例AMI患者中，有2例患者住院期间死于心室纤颤，且均发生于MVA组。结论 ST段抬高的AMI患者跨壁复极离散度显著增加，且发病3天内始终处于较高水平，MVA组TDRc显著延长，心脏风险大于非MVA组；自主神经功能失调参与了ST段抬高的AMI患者跨壁复极离散度扩增的形成。

关键词: 急性心肌梗死, ST段抬高, 室性心律失常, 跨壁复极离散度

Abstract: [Abstract] Objective To study the alteration of transmural dispersion of repolarization (TDR) and its relationship to ventricular arrhythmia or automatic nerve system dysfunction in patients with ST segment elevated acute myocardial infarction. Method 129 STE-AMI cases which were not capable being revascularized(AMI group) and 36 cases of control(control group) were enrolled randomizedly. The values corrected TDR(TDRc) between AMI and control groups, and TDRc recorded at the time point of in-charged, the 2th day and the 3th day were compared. The correlationship between standard deviation of NN intervals (SDNN) and TDRc were probed; Patients in AMI group were divided into malignant ventricular arrhythmia(MVA) group and non-MVA group according to Holter outcomes, and the TDRc of the 2 groups were also compared. Result (1) TDRc of AMI group was much higher than the corresponding values in control group (P<0.001), whereas there was no remarked difference among the TDRc values at different time-points of AMI group(P>0.05).(2) Significant negative correlationship was found between TDRc and SDNN in AMI group(r=-0.258, P< 0.05);(3) TDRc of MVA group was higher than those in non-MVA group(P<0.01).(4) there were 2 cases who died of ventricular febrilation in MVA group while no dead occurred on non-MVA group. Conclusion TDRs of STE-AMI cases are significantly elevated and sustain a high-level during the first 3 days at least; In comparison with non-MVA group, the MVA group was demonstrated with higher TDRc and cardiovascular risk; The automatic nerve system may contribute to the enlargement of TDR of non-AMI patients.

Key words: acute myocardial infarction, ST segment elevation, ventricular arrhythmia, transmural dispersion of repolarization