治疗性内镜逆行胰胆管造影取石术前后校正的QT离散度变化及影响因素

Change of corrected QT dispersion before and after stone removal by therapeutic endoscopic retrograde cholangiopancreatography and its influencing factors

摘要:

目的 探讨治疗性内镜逆行胰胆管造影(ERCP)取石术前后校正的QT离散度(QTcd)变化及影响因素。方法 连续入选2018年6月至2019年1月在南京医科大学第二附属医院行治疗性ERCP取石术的患者61例作为研究对象。分别在术前、术后3h、术后24h记录静息12导联心电图。术后3h QTcd较术前增加者纳入QTcd增加组,反之纳入QTcd降低组。采用SPSS 23.0统计软件进行统计学分析。依据数据类型,组间比较分别采用t检验或χ²检验。多因素logistic回归分析筛选ERCP取石术后3h QTcd增加的危险因素。结果 61例患者中1例行ERCP取石术后即刻出现室颤,最终获得60例完整数据。ERCP取石术前、术后3h及术后24h的QTcd分别为(29.05±11.09)、(36.00±13.46)及(21.81±10.52)ms,术后3h QTcd较术前及术后24h均升高,差异具有统计学意义(P＜0.05)。多因素logistic回归分析结果显示,女性(OR=15.895,95%CI 2.505～100.853)和估算肾小球滤过率(eGFR)(OR=1.039,95%CI 1.003～1.077)是ERCP取石术后3h QTcd增加的危险因素。结论 治疗性ERCP取石术后短期(3h)内可出现一过性QTcd增加,提示术后短期(3h)内的恶性心律失常风险增加。女性和eGFR是术后3h QTcd增加的危险因素。

Abstract:

Objective To investigate the change of corrected QT dispersion (QTcd) before and after stone removal by therapeutic endoscopic retrograde cholangiopancreatography (ERCP) and the related influencing factors. Methods A total of 61 patients who underwent therapeutic ERCP for stone removal in our hospital from June 2018 to January 2019 were consecutively enrolled as subjects. Resting 12-lead electrocardiography (ECG) was performed before and in 3h and 24h after operation. The patients with QTcd in 3h after operation higher than the value before were assigned into QTcd-increased group, otherwise were into QTcd-reduced group. Statistical analysis was performed using SPSS 23.0. Student t test or Chi-square test was used for comparison between groups on different data types. Multivariate logistic regression analysis was applied to screen the risk factors of QTcd increase at 3h post-ERCP. Results Among the 61 patients, 1 of them experienced ventricular fibrillation immediately after ERCP, and so complete data were obtained from the left 60 patients. The average QTcd value was (29.05±11.09), (36.00±13.46) and (21.81±10.52)ms respectively, before and at 3h and 24h post-ERCP. The value at 3h after ERCP was significantly higher than those at the other 2 time points (P<0.05). Multivariate logistic regression analysis showed that female (OR=15.895,5%CI 2.505-100.853) and estimated glomerular filtration rate (eGFR, OR=1.039,5%CI 1.003-1.077) were the risk factors for QTcd increase at 3h post-ERCP. Conclusion Therapeutic ERCP can lead to QTcd increase in a short time (3h) after stone removal by ERCP, which suggesting increased risk for malignant arrhythmia at that duration. Female and eGFR are the risk factors for QTcd increase at 3h post-ERCP.