溶栓治疗的急性心肌梗死患者心率变异性变化的临床意义  

Clinical implication of the change of heart rate variability in acute myocardial infarction patients with thrombolytic therapy

作　　者：祁必富[1] 蒋锡嘉[1] 许家俐[1] 

机构地区：[1]武汉大学人民医院急诊科,湖北武汉430060

出　　处：《中国急救医学》2004年第8期556-558,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的　观察急性心肌梗死 (AMI)溶栓治疗患者的心率变异性 (HRV)变化并对该变化的意义进行临床评价。方法　 4 1例AMI患者根据治疗方法分为两组 :溶栓再通组 2 1例 ,传统治疗组 2 0例。应用动态心电图、多普勒超声心动图观察两组患者起病后 2周、1个月、3个月、6个月HRV及左室射血分数 (LVEF)的动态变化。结果　除 3个月时的SDANN(2 4h每 5min正常R -R间期平均值的标准差 )外 ,溶栓再通组在 2周、1个月、3个月、6个月的SDNN(2 4h正常R -R间期标准差 )、SDANN、r-MSSD(2 4h相邻正常R -R间期差值的均方根值 )均高于传统治疗组相应时间段的数值 (P <0 0 5或 <0 0 1) ;同组内比较 ,3个月、6个月时的SDNN、SDANN、r-MSSD均高于 2周时的数值 (P <0 0 5或 <0 0 1) ,1个月时的HRV参数虽较 2周时高 ,但无统计学意义(P >0 0 5 )。溶栓再通组LVEF在 2周、1个月、3个月、6个月时均较传统治疗组相应时间段高 (P <0 0 5 )。 2周时动态心电图上记录的溶栓再通组的室性心律失常低于传统组 (33 3%vs 75 % ,P <0 0 5 ) ,有室性心律失常者同无室性心律失常者相比 ,前者的HRV参数 (SDNN)较低 (P <0 0 5 )。结论　溶栓后冠脉再通的急性心梗患者的HRV较高 ,说明冠脉再通使心脏自主神经系统功能失衡得到纠正 。Objective To observe the change of heart rate variability in acute myocardial infarction patients with thrombolytic therapy,and evaluate the clinical implication of the change. Methods 41 patients with acute myocardial infarction were divided into two groups according to their treatment methods:①21 patients with thrombolytic therapy and artery patency, ②20 patients were treated with conventional method. We used ambulatory electrocardiogram and Doppler echocardiogram to observe the dynamic change of HRV and LVEF in two weeks, one month, three monthes and six monthes after the onset of AMI. Results Except for SDANN in three monthes, SDNN, SDANN, r-MSSD of thrombolytic therapy group with artery patency were higher than that of conventional treatment patients in the corresponding time in all the four monitored time ( P <0 05 or <0 01), SDNN,SDANN,r-MSSD in three monthes and six monthes were higher than those in two weeks within the same group comparison ( P <0.05 or <0.01), though the HRV parameters in one month were higher than that in two weeks, there was no statistical significance ( P >0.05). LVEF of thrombolytic treatment group with artery patency in two weeks, one month, three monthes and six monthes was higher than that of conventional therapy patients in the corresponding time ( P <0.05). The prevalence of VA events of thrombolytic treatment group with artery patency in ambulatory electrocardiogram in two weeks was lower than that of conventional therapy patients in the same time. Compared with patients without VA events, HRV(SDNN) of patients with VA events was lower( P <0.05). Conclusion Acute myocardial infarction patients with thrombolysis-induced artery patency have higher HRV. This means that coronary artery patency may protect the autonomic nervous system function, reduce the difference of myocardial repolarization and conduction, reduce ventricular arrhythmic events.

关 键 词：溶栓治疗 急性心肌梗死 心率变异性 左室射血分数 动态心电图 多普勒超声心动图 

分 类 号：R542.2[医药卫生—心血管疾病]