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（１３６±７９）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＜０００１），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）Ｋｉｌｉｐ分级Ⅲ级以上的患者（１７例）ＨＲＶ值均低于Ｋｉｌｉｐ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＜００５），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。?
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 except HF. There was not any difference of HRV between patients who had received thrombolytic therapy and those who hadn′t, so did infarct related coronary artery patency. Some criteria like SDNN, TF, and LF were significantly lower in patients with severe cardiac events before discharge than those didn′t have. Conclusion HRV decreased significantly after AMI and lost its circadian variation. Decreased HRV in the early stage after AMI had closed relationship with severe cardiac events. HRV was associated with left ventricular function. There was no relationship between HRV and the location of infarct, nor did infarct related coronary artery patency.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
1999年第2期107-110,共4页
Chinese Journal of Cardiology
