窦性心率震荡现象对老年人急性心肌梗死后再发心脏事件的影响  

The significance of heart rate turbulence as a predictor of subsequent heart incident after acute myocardial infarction in old patients

作　　者：王德昭[1] 李运田[2] 付贵琴[3] 李志民[3] 刘小华[3] 黄健芬[3] 胡新科[3] 王军[3] 赵岳[3] 

机构地区：[1]首都医科大学附属北京同仁医院,北京100730 [2]解放军305医院介入科 [3]北京市门头沟区医院心内科

出　　处：《中国民康医学》2005年第11期650-653,共4页Medical Journal of Chinese People’s Health

摘　　要：目的:回顾性的分析窦性心率震荡现象(Heart Rate Turbu lence,简称HRT)对老年人(≥60岁)急性心肌梗死后再发心脏事件(再次心肌梗死、再次心绞痛、恶性心律失常、心衰和猝死)的影响。方法:选择自1997年2月至2004年12月的首次因急性心肌梗死入院的患者405例,其中急性心肌梗死后2到3周内有室性早搏(室早)并且在24小时动态心电图(Holter)或监护导联上能记录到室早前有至少3个正常的窦性心搏,室早后有连续20个以上窦性心搏,且年龄≥60岁的病人204例。记录可能影响预后的相关指标,包括年龄、性别、吸烟、高血压、血脂异常、糖尿病、家族史、尿酸升高、急性心肌梗死部位、采取治疗措施、左室射血分数(均采用面积长轴法)、心肌梗死二级预防用药(ACE I、Asp irin、Statin、β-B lockor等)以及HRT分类。HRT 0为窦性心率震荡初始(TO)<0并且窦性心率震荡斜率(TS)>2.5 m s/RR I(RRInterval);HRT 1为TO≥0或者TS≤2.5 m s/RR I;HRT 2为TO≥0并且TS≤2.5 m s/RR I。结果:204例男98例,年龄(70.55±6.65)岁;女106例,年龄(70.93±6.28)岁,平均随访(22±12.3)个月,其中因再发心脏事件二次入院的78例,入院后死亡的21例,随访期内院外死亡的16例。Logistic多元回归分析显示老年人急性心肌梗死后再发心脏事件与HRT、糖尿病、LVEF≤55%及吸烟显著相关,其相对危险系数分别为18.915(P<0.001)、11.865(P=0.001)、6.444(P=0.011)及4.905(P=0.043)。结论:窦性心率震荡现象是老年人急性心肌梗死后再发心脏事件良好的预测指标。Objective： We retrospectively analyse the significance of heart rate turbulence as a predictor of occurring heart incident（ including myocardial infarction, angina pectoris, heart failure, malignant arrhythmia and sudden death ） after Acute Myocardial Infarction. Methods：Four hundred and five patients with AMI were enrolled since February in 1997 to December in 2004. Among them two hundred and four cases accorded with following qualifications： first, the patients had a single ventricular premature beat in Hoher electrocardiograms or in monitor records between two to three weeks postinfarction ; second, they experienced echocardiography examination and LVEF was calculated by the area - length method ; third, there must to be three sinus heart rhythms before ventricular premature and at least twenty sinus heart rhythms after that ; last, all the patients must be reach to sixty years old or older. All the patients were divided .into two groups, one of it was suffering heart incident and another was none. Some risk factors may be influence heart incident after myocardial infarction, such as sex, smoke, hypertension, diabetes mellitus, abnormal cholesterol, family history, high uric acid, Acute Myocardial Infarction places, method of therapy, drugs（ such as Aspirin, Angiotensin Conversion Enzyme Inhibitor, Statins, and β - Blockor etc. ） after infarction, category of Heart Rate Turbulence（HRT）. HRT category 0 means turbulence onset （TO） 〈0 and turbulence slope（TS） 〉2. Sms/RRI, HRT category 1 means TO≥0 or TS≤2. Sms/RRI, HRT category 2 means TO ≥0 and TS≤2.5ms/RRI. Results： two hundred and four cases were involved, ninty -eight were male with age （70.55 ±6.65 ） years old, one hundred and six were female with age （70.93 ±6.28 ） years old. During a follow - up of （22 ± 12.3 ） months, ninty - eight patients suffered heart incident again. On logistic multivariate analysis, HRT category 2 or HRT category l ,diabetes mellitus,LVEF≤ 55% and smoke were the most signific

关 键 词：窦性心率震荡 急性心肌梗死 再发心脏事件 

分 类 号：R541.7[医药卫生—心血管疾病] R542.22[医药卫生—内科学]