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目的通过观察室性早搏(室早)患者治疗前后同步12导联心电图中QT离散度(QTd)及24小时动态心电图变化,分析胺碘酮和索他洛尔作用机制以及QTd应用的临床意义。方法室早患者60例包括Ⅰ组(胺碘酮静脉+口服),Ⅱ组(胺碘酮单纯口服)和Ⅲ组(索他洛尔口服),每组20例。所有患者均在用药前、用药后5天分别检测QT离散度(包括正常波QTd、室早波QTd及室早波随后正常波QTd),以及用药前、用药后两周分别做24小时动态心电图。结果所有患者用药前和用药后正常波QTd有明显的统计学差别(P<0.001),但用药前和用药后5天室早波QTd及室早随后正常波QTd无明显的统计学差别(P>0.05)。Ⅰ组患者总有效13例(65%),Ⅱ组患者总有效13例(65%),Ⅲ组患者总有效11例(55%)。Ⅰ组与Ⅱ组疗效较Ⅲ组为高,但经统计学检验无明显差别(P>0.05)。将所有患者按治疗后有效和无效分为两部分,有效部分和无效部分用药前和用药后5天QTd测定值均有明显的统计学差别(P<0.001),但两部分用药前后QTd差值无明显统计学差别(P>0.05)。结论胺碘酮和索他洛尔治疗效果相似,两者均可降低室早患者的QTd。QTd对于抗心律失常药物疗效无预测价值。
Objective To observe the effect of amiodarone and sotalol and the clinical significance of QTd by observing the changes of QTd and 24-hour electrocardiogram in patients with ventricular premature beats and ventricular tachycardia before and after treatment. Methods 60 cases of patients with early ventricular disease, including Ⅰ (amiodarone intravenous + oral), Ⅱ (amiodarone simple oral) and Ⅲ (sotalol oral), 20 cases in each group. All patients were tested for QT dispersion (including QTd of normal wave, QTd of ventricular premature ventricular contractions and QTd of ventricular premature beat and normal wave of QTd) before treatment and 5 days after treatment, and 24-hour Holter monitoring before treatment and two weeks after treatment . Results Before treatment and after treatment, the normal wave QTd showed a significant difference (P <0.001), but there was no significant difference between the QTd and the normal wave QTd in the 5 days before and after medication (P > 0.05). The total effective rate was 13 (65%) in group I, 13 (65%) in group II and 11 (55%) in group III. The efficacy of group Ⅰ and group Ⅱ was higher than that of group Ⅲ, but no significant difference was found by statistical test (P> 0.05). All patients were divided into two parts according to the effective and ineffective after treatment. The QTd values of the effective part and the invalid part before treatment and after 5 days were significantly different (P <0.001), but the QTd difference No significant difference (P> 0.05). Conclusions Amiodarone and sotalol have similar effects, both of which can reduce QTd in patients with early ventricular tachycardia. QTd has no predictive value for antiarrhythmic drug efficacy.