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目的:观察急性ST段抬高性心肌梗死(STEMI)患者QT间期、Tp-ec(校正的T波的顶点到T波的终点的时间)和Tp-e/QT指标的变化及这些指标与恶性心电生理事件的相关性。方法:急性STEMI患者60例,测量并计算梗死相关和非梗死导联QT、QTc、Tp-ec、Tp-e/QT比值,记录1年内恶性心电生理事件。正常心电图60例作为对照。结果:①急性STEMI 12h内梗死和非梗死导联QTc明显延长(P<0.01),1周和1个月回复正常水平。梗死相关导联12h内Tp-ec间期比非梗死导联及对照组均明显延长(均P<0.01),1周和1个月逐渐回复正常。Tp-e/QT比值在梗死相关导联比其他导联明显增大(P<0.01),随之逐渐回复,但仍与对照组差异有统计学意义(P<0.01)。②QTc 440ms作为截点电生理事件发生差异无统计学意义(P>0.05),而分别以Tp-ec100ms和Tp-e/QT比值0.25作为截点恶性电生理事件发生差异有统计学意义(P<0.05)。结论:在心肌梗死急性期Tp-ec,尤其是Tp-e/QT比值增加,与恶性电生理事件相关,是预测急性STEMI后恶性电生理事件的指标。
OBJECTIVE: To observe the changes of QT interval, Tp-ec (time from the apex of T wave to the end of T wave) and Tp-e / QT index in patients with acute ST-elevation myocardial infarction (STEMI) Correlation of malignant electrophysiological events. Methods: Sixty patients with acute STEMI were enrolled in this study. The ratio of QT, QTc, Tp-ec and Tp-e / QT in infarction-related and non-infarction leads were measured and calculated. Malignant electrophysiological events were recorded within 1 year. 60 cases of normal ECG as a control. Results: ① The QTc of infarction and non-infarction leads were significantly prolonged in acute STEMI (P <0.01), and returned to the normal level in 1 week and 1 month. The Tp-ec interphase in infarct-related lead 12h was significantly longer than non-infarct lead and control group (all P <0.01), and returned to normal in 1 week and 1 month. Tp-e / QT ratio in infarction-related lead significantly increased compared with other lead (P <0.01), followed by gradual recovery, but still with the control group, the difference was statistically significant (P <0.01). There was no significant difference in QTc 440ms as a cut-point electrophysiological event (P> 0.05), but statistically significant difference was found between Tp-ec100ms and Tp-e / QT ratio of 0.25 as the cut-off point in malignant electrophysiological events (P < 0.05). CONCLUSION: The increased Tp-ec, especially Tp-e / QT ratio in the acute phase of myocardial infarction is associated with malignant electrophysiological events and is an indicator of malignant electrophysiological events after acute STEMI.