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急性心肌梗塞早期的心率变异性测定 |
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权薇薇 戚文航 刘霞 张娟嬴 杨丽英
【摘要】 目的 研究急性心肌梗塞(AMI)较早期的心率变异性(HRV)改变及其预后意义，探讨不同梗塞部位、心功能、溶栓与再通对HRV的影响。方法 AMI患者50例，Holter记录在胸痛发作24小时之内开始进行，平均(13.6±7.9)小时；健康对照组50例。结果 (1)AMI组HRV各项指标均低于正常对照组，统计学达显著意义(P＜0.001)，并且正常RR间期的标准差(SDNN)，低频(LF)等成分失去了昼夜间的差异。AMI患者24小时HRV曲线较为平坦，而对照组显示出明显的昼夜节律性变化，夜间曲线范围高，凌晨觉醒前达峰值，觉醒后骤然下降，白昼则较为平坦。(2)前壁梗塞与非前壁梗塞相比，心率明显增快，各项HRV指标虽有下降但未达统计学意义。(3)Killip分级Ⅲ级以上的患者(17例)HRV值均低于Killip分级Ⅰ、Ⅱ级(33例)的患者，除高频(HF)外均达到统计学显著意义(P＜0.05)，并且心率明显增快。(4)溶栓与再通后HRV部分指标有所增加，心率下降，但与血管未通者相比没有统计学意义。(5)住院期间发生严重心脏事件的患者(12例)HRV水平降低，SDNN、LF、总频谱(TF)下降达统计学显著意义，同时心率明显增快。结论 研究结果提示，AMI后HRV明显下降，失去昼夜节律性变化，并且AMI早期降低的HRV与住院期间的严重心脏事件密切相关，为临床及早对高危患者采取干预措施提供了理论依据。AMI后HRV水平同心功能密切相关，随Killip分级的增高而下降。不同梗塞部位以及溶栓与否对HRV影响不大。
【关键词】 心肌梗塞 心率变异性
Heart rate variability measurement after acute myocardial infarction QUAN Weiwei, QI Wenhang, LIU Xia, et al. Ruijin Hospital, Shanghai Second Medical University, Shanghai 200025
【Abstract】 Objective To investigate heart rate variability (HRV) in the early stage after acute myocardial infarction (AMI) and to find the influence of myocardial infarction location, heart function, thrombolytic therapy and infarct-related artery patency on HRV.Methods HRV analysis with 24-hour Holter tapes were performed in 50 patients after chest pain onset within 24 hours (mean 13.6±7.9 h ).Results All values of HRV after AMI were significantly lower compared with the controls (P<0.0001), and lost its circadian variation showing a low and plain curve during the whole day. But with the control group, the circadian variation existed significantly. The acrophace occured during the sleeping hours followed by an abrupt decrease in the morning after awakening and kept a low level all the daytime. Comparing HRV between anterior and non-anterior wall infarction, we did not find any statistical difference. Patients with Killip class III-IV (n=17) had significantly lower HRV values than those with class I-II(n=33), P<0.05 excep[1] [2] 下一页
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