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目的:探讨实时超声血流速度的估算和24h动态心电图记录与急性心肌梗死恶性室性心律失常患者的预后关系。方法:采用实时超声血流速度估算与24h动态心电图记录对80例急性心肌梗死恶性室性心律失常患者(观察组)和80例急性心肌梗死非恶性室性心律失常患者(对照组)进行评估,并比较两组患者预后。结果:观察组和对照组实时超声血流速度各指标差异显著[Ts-sD:(44.6±12.4)ms︰(29.8±6.8)ms;Ts-maxD:(138.8±39.1)ms︰(84.6±18.1)ms;Te-masD:(131.5±35.5)ms︰(82.3±17.58)ms;均P<0.05]。4h动态心电图记录:观察组80例(100%)均为持续性室性心动过速或心室颤动,对照组3例(3.75%)为一过性室性心动过速,两组差异显著(P<0.01)。1年内病死率观察组为24例(30%),对照组2例(2.5%),差异显著(P<0.01)。观察组中5例接受植入型心律转复除颤器,1年内均存活。结论:经实时超声血流速度估算值以及24h动态心电图记录与急性心肌梗死恶性室性心律失常患者预后有关。对该类患者应立即采取电除颤、电复律及相关药物救治措施,以改善预后,降低病死率。
OBJECTIVE: To investigate the estimation of real-time ultrasound blood flow and the relationship between 24h ambulatory electrocardiogram recording and prognosis of patients with malignant ventricular arrhythmias after acute myocardial infarction. Methods: Eighty patients with malignant ventricular arrhythmias (observation group) and 80 patients with acute myocardial infarction (non-malignant ventricular arrhythmia) (control group) were evaluated by real-time ultrasound flow velocity estimation and 24h Holter recording. And compared the prognosis of two groups. Results: There were significant differences in real-time ultrasound blood flow velocity between the observation group and the control group (Ts-sD: (44.6 ± 12.4) ms: (29.8 ± 6.8) ms; Ts- maxD: (138.8 ± 39.1) ms: ); Te-masD: (131.5 ± 35.5) ms: (82.3 ± 17.58) ms; all P <0.05]. 4h Holter recording: 80 cases (100%) in the observation group were both persistent ventricular tachycardia and ventricular fibrillation, and 3 cases (3.75%) in the control group were transient ventricular tachycardia, with significant difference between the two groups <0.01). The mortality was observed in 24 cases (30%) in one year and two cases (2.5%) in control group, with significant difference (P <0.01). Five patients in the observation group received implantable cardioverter-defibrillator and survived within 1 year. CONCLUSION: The real-time estimation of the ultrasonic blood flow velocity and 24-hour Holter recording correlate with the prognosis of patients with malignant ventricular arrhythmias after acute myocardial infarction. Such patients should take immediate defibrillation, cardioversion and related drug treatment measures to improve the prognosis and reduce mortality.