作者：颜崇平 Chong-ping高血压病患者冠心病区域性差值比较临床意义clinicalsignificancecoronaryheartdiseasemyocardialischemiathree十二导联心电图异常改变心肌缺血冠状动脉造影冠状动脉病变体表心电图心肌肥厚不同疾病resultschangesregion
摘要：目的 探讨区域性QT间期差值(QTrd)能否作为鉴别高血压和冠心病两种不同疾病引起的心肌缺血的指标.方法 将80例因体表心电图出现ST段异常改变,经冠状动脉造影确诊为冠心病、高血压病患者分为冠心病组、高血压并冠心病(CH)组及高血压组.把体表十二导联心电图分为Ⅰ、aVL,Ⅱ、Ⅲ、aVF,V2～4,V5～6 4个区域,测量各区域的QTrd并进行分析和比较.结果 在Ⅰ、aVL区域,各组都有部分QTrd≥40 ms;Ⅱ、Ⅲ、aVF,V2～4,V5～63个区域,有1个区域的QTrd≥40 ms的百分比,在高血压组为88%,CH组为60%,冠心病组无一例＞40 ms.结论 高血压病时,如心电图出现ST段异常改变,在Ⅱ、Ⅲ、aVF,V2～4,V5～63个区域中,有1个区域的QTrd＞40 ms,则心肌肥厚伴缺血的可能性大,如这3个区域中的QTrd都＜40 ms,可能为冠状动脉病变引起的心肌缺血的表现. Abstract： Objective To analyze whether regional QTrd could be an index to identify myocardial ischemia caused by hypertension or coronary heart disease(CHD). Methods According to the changes of ST segment in ECG and coronary arteriongraphy,98 caese were divided into three groups :coronary heart disease ( C ) group, hypertension with coronary heart disease ( CH ) group and hypertension ( H )group. QTrd was measured and compared in four regions(lead Ⅰ and aVL,lead Ⅱ , Ⅲ and aVF,lead V2 ～4and lead V5～6)in ECC of each group. Results QTrd＞≥40 ms was seen in all three groups in the region of lead I and aVL. The rate of QTrd≥40 ms in one of the other three regions was 88% ,60% and 0 in group H, CH and C respectively. Conclusions In hypertension, myocardial hypertrophy with ischemia is highly possible if there is QTrd≥40 ms in any one of the three regions( Ⅱ, Ⅲ and aVF, V2～4, V5 ～6 );if the QTrd≤40 ms in these all three regions myocardial ischemia may be caused by coronary disease.
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