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目的研究QT间期离散度在室性心律失常患者中预测抗心律失常药物致心律失常的作用。方法对364例室性心律失常患者使用抗心律失常药物,测量治疗前后QTcd及动态心电图,并与120例健康人进行对照。结果室性心律失常治疗前与对照组比较,QTcd差异有统计学意义(P<0.01)。治疗好转组QTcd明显降低,与对照组差异无统计学意义(P>0.05),无效组QTcd无明显变化,致心律失常组QTcd反而升高。QTcd在服药后3~4d开始变化,5~7d时变化幅度最大,12~14d变化幅度变小。不同药物致心律失常发生率不同,乙吗噻嗪致心律失常发生率最高(11.2%),胺碘酮6.2%,普罗帕酮10.5%,三组间比较差异无统计学意义,P>0.05;乙吗噻嗪、胺碘酮、普罗帕酮用药2周后QTcd比较差异无统计学意义(P>0.05)。结论QTcd值的变化是预测抗心律失常药物致心律失常作用的灵敏而重要的指标。
Objective To investigate the role of QT interval dispersion in predicting arrhythmia induced by antiarrhythmic drugs in patients with ventricular arrhythmias. Methods 364 patients with ventricular arrhythmia were treated with antiarrhythmic drugs, QTcd and Holter measured before and after treatment, and compared with 120 healthy subjects. Results Before treatment, ventricular arrhythmia compared with the control group, QTcd difference was statistically significant (P <0.01). QTcd in treatment improved group was significantly lower than that in control group (P> 0.05), QTcd in ineffective group had no obvious change, but QTcd increased in arrhythmia group. QTcd began to change 3 ~ 4d after taking medicine, the biggest change range was from 5 to 7d, and the change range from 12 to 14d became smaller. The incidence of arrhythmia caused by different drugs was the highest, the incidence of arrhythmia caused by ethinothiazide was the highest (11.2%), amiodarone 6.2% and propafenone 10.5%. There was no significant difference among the three groups (P> 0.05). There was no significant difference in QTcd between the two groups after 2 weeks of treatment with etoposide, amiodarone and propafenone (P> 0.05). Conclusions The change of QTcd value is a sensitive and important index for predicting the arrhythmic effects of antiarrhythmic drugs.