冠状动脉慢性闭塞病变开通前后QT间期离散度的变化

发布时间：2018-05-03 22:36

本文选题：冠状动脉 + 慢性闭塞病变　；参考：《郑州大学》2016年硕士论文

【摘要】：背景QT间期在不同导联的差异这一现象早已被发现,在很长时间内认为与非同步记录所造成的测量误差相关,直到1985年Campbell和Cowan等采用了12导联同步记录心电图后,才首先证明了这种现象是一种规律性的存在,最终提出了QT间期离散度(QT dispersion,QTd)的概念,即体表标准12导联心电图不同导联间最大QT间期(QTmax)与最小QT间期(QTmin)的差值,是心肌复极的时间的最大差值。Day等在1990年发现QTd增大与室性心律失常及猝死密切相关,并提出QTd可作为预测恶性室性心律失常及猝死的指标。随后的大量临床研究进一步明确了QTd的重要临床意义,至今,QTd已作为了无创性评价心室肌复极非同步性及反应心室肌复极的不均一性和电不稳定性的一个重要指标。冠状动脉慢性完全闭塞(chronic total occlusions,CTO)病变是指冠状动脉在粥样硬化病变基础上由于血栓形成、机化导致冠状动脉血管完全阻塞,且闭塞病程超过3个月。冠状动脉CTO病变是一类常见的冠状动脉复杂病变,约占冠状动脉造影检出冠状动脉明显狭窄患者的20%~30%,随着操作技术和器械的发展,近年来CTO患者接受经皮冠脉介入治疗(percutaneous coronary intervention,PCI)比例逐渐增加,但仅占全部PCI病例的20%,可见,CTO病变PCI选择仍有部分争议。绝大多数CTO病变都存在同向或者逆向的侧枝循环,使闭塞段远端保持一定的血供,但,即使侧枝循环建立充分在功能上也仅相当于90%狭窄的血管,而这些处于缺血状态的心肌区域可能损伤心室肌的复极。多个临床研究证实心肌微循环灌注不足可延长QTd,且成功的血运重建可减少QTd。有相关报道指出CTO经PCI成功后可减少QTd,但不同冠状动脉慢性闭塞病变行PCI成功后对QTd影响及对比的研究较少。本实验旨在通过观察对比不同冠状动脉CTO病变开通后对QTd的影响,为CTO病变选择PCI提供更多的证据。目的观察和对比不同冠状动脉慢性闭塞病变经成功PCI后对QTd的影响方法以郑州大学第一附属医院心内科冠脉造影证实存在至少1支主要冠状动脉血管(左前降支、回旋支和右冠状动脉)慢性闭塞病变153例,根据CTO病变血管分为前降支慢性闭塞组52例、回旋支慢性闭塞组34例、右冠状动脉慢性闭塞组67例。采用标准同步12导联心电图对所有入组的患者术前及术后24小时进行心电图的测量与临床资料的采集。采用SPSS19.0统计软件对三组数据进行统计分析。结果1.三组患者基线资料相比较无统计学差异(P0.05);2.三组病例经成功PCI后QTd、QTcd较术前均降低(LAD-CTO 43.90±4.61vs.56.40±4.75 P0.001,45.46±4.87 vs.58.40±5.13 P0.001;LCX-CTO40.35±3.26 vs.49.06±4.57 P0.001,42.29±3.22 vs.51.42±4.65 P0.001;RCA-CTO 43.73±4.13 vs.53.97±4.95 P0.001,44.74±4.36 vs.55.22±5.28 P0.001),差异有统计学意义(P0.05);3.三组PCI前后的QTd、QTcd的差值分别为LAD-CTO(12.50±2.55)ms、(12.95±2.68)ms,LCX-CTO(8.71±2.31)ms、(9.13±2.43)ms,RCA-CTO(10.24±1.81)ms、(10.48±1.89)ms。它们两两间比较,差异均有统计学意义(P0.05)。结论CTO病变经成功PCI后,QTd、QTcd较术前降低,且CTO开通前后的QTd、QTcd减少程度由大到小依次为LAD-CTO、RCA-CTO、LCX-CTO。PCI成功开通CTO病变可能对防止快速室性心律失常的发生及改善临床预后具有积极作用。
[Abstract]:The difference of the background QT interval in the different leads has long been found. It is considered to be related to the measurement error caused by the asynchronous record for a long time. Until the 12 lead synchronous recording electrocardiogram was used in the Campbell and Cowan in 1985, it was first proved that this phenomenon was a regular existence, and finally the QT interval was put forward. The concept of QT dispersion (QTd), that is, the difference between the maximum QT interval (QTmax) and the minimum QT interval (QTmin) between the 12 lead electrocardiograms of the body surface standard, the maximum difference between the time of the repolarization of the myocardium, the maximum difference of.Day, and so on, found in 1990 that the increase of QTd is closely related to ventricular arrhythmias and sudden death, and that QTd can be used as a predictor of malignant ventricular arrhythmia. A large number of subsequent clinical studies further clarify the important clinical significance of QTd. To date, QTd has been an important indicator of noninvasive evaluation of ventricular repolarization inhomogeneity and response to ventricular repolarization inhomogeneity and electrical instability. Coronary artery slow complete occlusion (chronic total occlusions, CTO) disease. Change is the coronary artery occlusion on the basis of atherosclerosis on the basis of atherosclerotic lesions, which causes complete occlusion of coronary arteries and the course of occlusion for more than 3 months. Coronary CTO lesion is a common type of complex coronary artery disease, which accounts for 20%~30% of patients with coronary artery stenosis with coronary angiography. In recent years, the proportion of CTO patients receiving percutaneous coronary intervention (percutaneous coronary intervention, PCI) has gradually increased, but only 20% of all PCI cases have been found. It is clear that there is still some controversy in the PCI selection of CTO lesions. Most CTO lesions have the same direction or reverse collateral circulation, which keeps the distal end of the block to a certain amount of blood. Supply, however, even if the collateral circulation is established to fully function as only 90% narrow blood vessels, and these myocardial regions in the ischemic state may damage the repolarization of the ventricular muscle. Multiple clinical studies have confirmed that myocardial microcirculation perfusion deficiency can prolong QTd, and the successful revascularization can reduce QTd. related reports that CTO is successful after PCI. QTd can be reduced, but there are few studies on the effect and contrast of QTd after PCI success in different coronary artery chronic occlusive lesions. This experiment aims to provide more evidence for the selection of PCI in CTO lesions by observing and comparing the effects of different coronary artery CTO lesions on QTd. The purpose of this study is to observe and succeed in the successful P of the chronic occlusion of coronary artery disease. In the Department of Cardiology, the First Affiliated Hospital of Zhengzhou University, there were 153 cases of chronic occlusion of at least 1 main coronary arteries (left anterior descending branch, cyclotron branch and right coronary artery) in the First Affiliated Hospital of Zhengzhou University. 52 cases were divided into anterior descending chronic occlusion group (52 cases), 34 cases of circumflex branch chronic occlusion group and right coronary artery slow down. 67 cases in the sexual block group. The standard synchronous 12 lead electrocardiogram was used to measure the electrocardiogram and the clinical data of all the patients before and after 24 hours after the operation. The data of three groups were statistically analyzed with SPSS19.0 software. The results of the baseline data of the 1. three groups were not statistically different (P0.05); 2. three cases were successful. After PCI, QTd, QTcd decreased compared with pre operation (LAD-CTO 43.90 + 4.61vs.56.40 + 4.75 P0.001,45.46 + 4.87 vs.58.40 + 5.13 P0.001; LCX-CTO40.35 + 3.26 vs.49.06 + 4.57 P0.001,42.29 + 3.22 vs.51.42 4.65), 43.73 + 4.13 + 4.95 + 4.36 + 4.36 The difference between QTd and QTcd before and after PCI was LAD-CTO (12.50 + 2.55) ms, (12.95 + 2.68) ms, LCX-CTO (8.71 + 2.31) ms, (9.13 + 2.43) ms, RCA-CTO (10.24 + 1.81) ms, (10.48 + 1.89) Ms. they were compared, the differences were statistically significant. The successful opening of CTO lesions from large to small to LAD-CTO, RCA-CTO, and LCX-CTO.PCI may have a positive effect on preventing the occurrence of rapid ventricular arrhythmia and improving the clinical prognosis.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.4

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