【作者】 闫贤良；

【导师】 李广平；

【作者基本信息】 天津医科大学 ， 内科学， 2011， 硕士

【摘要】 目的研究冠心病患者的心功能和肺动脉压力(Pulmonary arterial pressure, PAP)、心电指标之间的关系。方法队列入选2009年10月—2011年2月在天津医科大学第二医院心脏内科住院的冠心病患者151例,按照NYHA分级分为A组(I、II级)、B组(III级)、C组(Ⅳ级),比较3组之间的PAP、P波离散度(P dispersion, Pd)、QT间期(QT)、QT离散度(QT dispersion, QTd)、T波峰-末间期(Tpeak-Tend, Tpe)和经纠正后的QT(QTc)、QTd(QTcd)、Tpe(Tpec)之间的差异,并分析Pd和左房内径(Left atrial diameter, LAD)、QTd和左室舒张末径(Left ventricular end diastolic diameter, LVEDD)、Pd和QTd之间的关系。结果①A组、B组、c组患者的Pd分别为35.10±10.99ms,56.94±9.18ms, 68.87±8.63ms,差距有统计学意义(P<0.05)；LAD分别为38.55±7.80mm, 45.20±6.47mm,48.48±5.29mm,差距有统计学意义(P<0.05)；Spearman秩相关结果显示：Pd和LAD存在正相关(r=0.368,P<0.05)；②A组、B组、c组患者的QT分别为423±42ms,448±35ms,473±35ms,差距有统计学意义(P<0.05)；QTc分别为453±30ms,487±17ms,508±27ms,差距有统计学意义(P<0.05); QTd分别为55±13ms,78±15ms,92±15ms,差距有统计学意义(P<0.05); QTcd分别为59±15ms,90±16ms,101±18ms,差距有统计学意义(p<0.05); LVEDD分别为47.81±6.26mm,55.54±6.10mm,63.48±7.63mm,差距有统计学意义(P<0.05); Spearman秩相关结果显示：QTd和LVEDD存在正相关(r=0.602,p<0.05), QTcd和LVEDD呈正相关(r=0.610,P<0.05)；③A组、B组、c组患者的Tpe分别为85.59±10.66ms,99.00±12.76ms, 112.39±9.52ms,差距有统计学意义(P<0.05)；Tpec分别为96.20±12.42ms,106.67±20.59ms,120.77±13.76ms,差距有统计学意义(P<0.05)；④A组、B组、C组患者的PAP分别为23.88±6.07mmHg,43.29±13.47mmHg, 51.56±10.65mmHg,差距有统计学意义(P<0.05)；⑤相关性分析还显示：冠心病患者的Pd和QTd存在正相关(r=0.698,P<0.05)。结论①冠心病患者随着心功能的恶化,Pd有增加的趋势,发生房颤的风险增加；Pd和LAD呈正相关；②冠心病患者随着心功能的恶化,QT, QTc, QTd, QTcd有增加的趋势；发生恶性心律失常的风险增加；QTd, QTcd和LVEDD呈正相关；③冠心病患者随着心功能的恶化,Tpe、Tpec有增加的趋势,发生恶性心律失常的风险增加；④冠心病患者随着心功能的恶化,PAP有升高的趋势；⑤冠心病患者的Pd和QTd呈正相关。更多还原

【Abstract】 Objective:To study the relationship between heart function and pulmonary arterial pressure (PAP), ECG indices in patients in coronary heart disease (CHD).Methods:According to NYHA classification,151 patients who were inpatiented in our hospital were classified with group A(Ⅰ、Ⅱ), group B(Ⅲ), group C(Ⅳ), compare PAP, P dispersion (Pd), QT interval (QT), QT dispersion (QTd), Tpeak-Tend interval (Tpe) and corrected QT (QTc), corrected QTd (QTcd), corrected Tp-e (Tpec) among three groups, and analyzed of the correlation between Pd and LAD, QTd and LVEDD, QTcd and LVEDD, Pd and QTd respectively.Results:①The value of Pd of patients of group A, group B, group C were 35.10±0.99ms,56.94±9.18ms,68.87±8.63ms respectively, the difference reached statistical significance (p<0.05), The value of LAD of patients of group A, group B, group C were 38.55±7.80mm,45.20±6.47mm,48.48±5.29mm respectively, the difference reached statistical significance (p<0.05), Spearman rank correlation test showed that the value of Pd was positively and statistically correlated with the value of LAD(r=0.368,P<0.05).②The values of QT/QTc and QTd/QTcd of patients were inrceased gradually and significantly with the deterioration of heart function in group B vs group A, group C vs group B (QT:423±42ms,448±35ms,473±35ms, P<0.05; QTc: 453±30ms,487±17ms,508±27ms, P<0.05; QTd:55±13ms,78±15ms,92±15ms, p<0.05; QTcd:59±15ms,90±16ms,101±18ms, P<0.05), The values of LVEDD of patients were inrceased gradually and significantly with the deterioration of heart function in group B vs group A, group C vs group B (47.81±6.26mm, 55.54±6.10mm,63.48±7.63mm, P<0.05).Spearman rank correlation test showed that the values of QTd and QTcd were positively and statistically correlated with the value of LVEED(r=0.602, P<0.05, r=0.610, P<0.05 respectively).③The value of Tpe and Tpec of patients of group C were significantly enhanced with that of group B and group A (Tpe:85.59±10.66ms,99.00±12.76ms, 112.39±9.52ms, P<0.05; Tec:96.20±2.42ms,106.67±20.59ms,120.77±13.76ms, P<0.05). ④The value of PAP of patients of group A, group B, group C were 23.88±6.07mmHg,43.29±13.47mmHg,51.56±10.65mmHg respectively, the difference reached statistical significance (p<0.05).⑤Spearman rank correlation test also showed that the value of Pd was positively and statistically correlated with the value of QTd(r=0.698, P<0.05). Conclusion:①With the deterioration of heart function in CHD patients, Pd is enhanced, the risk that patients suffer from atrial fibrillation is increasing, the value of Pd was statistically significantly related to the value of LAD.②With the deterioration of heart function in CHD patients, QT, QTc, QTd and QTcd are enhanced, the patients with heart failure are more likely to suffer from malignant cardiac arrhythmia, the values of QTd and QTcd were statistically significantly related to the value of LVEDD.③With the deterioration of heart function in CHD patients, Tpe, Tpec are enhanced, the patients with heart failure are more likely to suffer from malignant cardiac arrhythmia.④With the deterioration of heart function in CHD patients, PAP is inceasing.⑤The value of Pd was statistically significantly related to the value of QTd.更多还原