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目的 研究急性心肌梗死（ＡＭＩ）患者ＱＴ离散度（ＱＴｄ）变化与室壁运动异常（ＲＷＭＡ）的关系。方法 应用多普勒超声心动图和１２ 导联同步记录心电图测定４３ 例ＡＭＩ患者（ＡＭＩ组）和３０ 例劳力型心绞痛患者（对照组）ＲＷＭＡ的范围和ＱＴｄ 值。结果 （１）ＡＭＩ组早期即存在明显的ＲＷＭＡ、ＲＷＭＡ程度计分明显高于对照组。ＡＭＩ后１ 周、４ 周的ＱＴｄ 值较对照组显著延长。（２）ＡＭＩ组ＱＴｄ 值随ＲＷＭＡ程度加重而逐渐延长，前侧壁ＡＭＩ的ＲＷＭＡ 的范围比下后壁ＡＭＩ显著增大，相应的ＱＴｄ 值亦显著延长。ＡＭＩ后１ 周、４ 周的ＱＴｄ 值与ＲＷＭＡ 的范围和程度计分乘积呈显著正相关（ｒ＝ ０．７８，ｒ＝ ０．７１，Ｐ均＜０．０１）。（３）ＡＭＩ的溶栓再通组ＲＷＭＡ的范围和程度计分较非溶栓组显著减少，前者的ＱＴｄ 值亦较后者显著减少。结论 ＡＭＩ后ＱＴｄ 显著延长，并与ＲＷＭＡ程度加重及范围扩大呈密切相关。
Objective To investigate the relationship between QTd changes and wall motion abnormalities (RWMA) in patients with acute myocardial infarction (AMI). Methods The ranges and QTd values of RWMA in 43 patients with AMI (AMI group) and 30 patients with labor-type angina pectoris (control group) were measured by Doppler echocardiography and 12-lead synchronous recording electrocardiogram. Results (1) There was obvious RWMA in the early stage of AMI, and RWMA score was significantly higher than that of the control group. QTd values of 1 week and 4 weeks after AMI were significantly longer than those of control group. (2) The QTd value of AMI group gradually increased with the increase of RWMA degree. The range of RWMA of AMI in frontal wall was significantly higher than AMI in inferior posterior wall, and the corresponding QTd value was also significantly prolonged. There was a significant positive correlation between the QTd values of 1 week and 4 weeks after AMI and RWMA scores (r = 0.78, r = 0.71, P <0.01). (3) The extent and degree of RWMA in thrombolysis thrombolysis group were significantly decreased in AMI group compared with non-thrombolytic group, and QTd value in the former group was significantly lower than the latter. Conclusion QTd was significantly prolonged after AMI and was closely related to the increase of RWMA and the widening of the scope.