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目的观察老年急性心肌梗死（ＡＭＩ）患者溶栓前后ＱＴ离散度（ＱＴｄ）的变化，分析其与室性心律失常的关系。方法测量４０例老年ＡＭＩ患者的ＱＴ间期，计算其ＱＴｄ及校正后的ＱＴ离散度（ＱＴｄｃ）。结果（１）ＡＭＩ组ＱＴｄ及ＱＴｄｃ大于１００ｍｓ患者中，室性心动过速（室速）、心室颤动（室颤）发生率明显高于ＱＴｄ、ＱＴｄｃ小于１００ｍｓ者（７３．０％及６．８％，Ｐ＜０．００１）。（２）溶栓再通组溶栓后ＱＴｄ及ＱＴｄｃ（分别为５１．２±２１．４及６２．８±２１．９ｍｓ）较溶栓前缩短（分别为７７．４±２１．１及９０．０±３０．６ｍｓ），差异均有显著性（Ｐ＜０．０５）；未再通组溶栓前后ＱＴｄ及ＱＴｄｃ差异无显著性（Ｐ＞０．０５）。结论老年ＡＭＩ患者ＱＴｄ、ＱＴｄｃ延长者室速及室颤发生率增高，溶栓后ＱＴｄ及ＱＴｄｃ缩短提示溶栓后血管再通。
Objective To observe the changes of QTd before and after thrombolysis in elderly patients with acute myocardial infarction (AMI) and analyze its relationship with ventricular arrhythmia. Methods QT interval was measured in 40 elderly patients with AMI. QTd and corrected QT dispersion (QTdc) were calculated. Results (1) The incidences of ventricular tachycardia and ventricular fibrillation were significantly higher in patients with AMI QTd and QTdc> 100ms than those with QTd and QTdc less than 100ms (73.0% and 6.8% respectively) %, P <0.001). (2) QTd and QTdc (51.2 ± 21.4 and 62.8 ± 21.9 ms, respectively) after thrombolysis thrombolysis were shorter than those before thrombolysis (77.4 ± 21.1 and 90 .0 ± 30.6ms), the differences were significant (P <0.05). There was no significant difference in QTd and QTdc before and after thrombolysis (P> 0.05). Conclusions The incidence of ventricular tachycardia and ventricular fibrillation in elderly patients with QI and QTdc prolongation is higher than that in elderly patients with AMI. Shortening of QTd and QTdc after thrombolysis suggests recanalization after thrombolysis.