急性冠状动脉综合征患者心率震荡的临床意义  

Clinical significance of heart rate turbulence in patients with acute coronary syndrome

作　　者：刘红源[1] 

机构地区：[1]武汉科技大学附属医院心内科,湖北武汉430064

出　　处：《临床荟萃》2007年第9期619-621,共3页Clinical Focus

摘　　要：目的 通过对急性冠状动脉综合征（acutecoronary syndrome, ACS）患者心率震荡（heart rate turbulence,HRT）现象的检测,探讨HRT现象在ACS中的临床意义.方法 对ACS61例、稳定型心绞痛（stable angina pectoris, SAP）30例及健康对照者30例进行24小时动态心电图检查,分别计算震荡初始（turbulence onset,TO）及震荡斜率（turbulence slope,TS）,并比较3组患者TO及TS均值.ACS组分为HRT异常亚组和HRT正常亚组,并比较复合心脏事件发生率.结果与SAP组及对照组比较,ACS组TO高[（0.15±1.26）% vs -（0.57±1.71）%、-（0.61±1.52）%],TS明显降低（3.21±2.37） ms/RR vs （6.64±1.82） ms/RR、（7.71±2.17） ms/RR,差异有统计学意义（P＜0.05）;而SAP组和对照组的TO值、TS值比较,差异无统计学意义（P＞0.05）.ACS组中急性心肌梗死 （acute Myocardial Infarction,AMI）患者与UAP患者比较,TO值和TS 值差异无统计学意义（0.17±1.39）% vs （0.13±1.28）%,（3.01±2.16） ms/RR vs （3.47±2.21） ms/RR（P＞0.05）.对ACS组患者随访6～48个月,HRT异常亚组的复合心脏事件发生率明显高于HRT正常亚组（44.44% vs 15.79%）（P＜0.05）.结论 ACS患者HRT现象明显减弱,HRT可作为评价ACS患者自主神经功能状态和发生心脏事件的独立预测因素.Objective To study the clinical significance of heart rate turbulence（HRT） in acute coronary syndrome （ACS）, HRT in patients with ACS was tested. Methods 24 hours Holter monitoring was examined in 61 patients with ACS（this group was divided into two subgroups： HRT abnormal group and HRT normal group）, 30 patients with stable angina pectoris （SAP） and 30 normal people. Turbulence onset （TO） and turbulence slope（TS） were calculated from Holter records. The mean value of TO, TS and the incidence of complex cardiac event between three groups were compared. Results Compared with SAP group and normal group, TO in ACS group was significantly higher[（0. 15± 1.26） % vs -- （0. 57± 1.71） %- （0. 61 ± 1.52） %], TS in ACS group was significantly lower （3.21 ± 2.37） ms/RR vs （6.64± 1.82） ms/RR, （7.71 ±2.17） ms/RR（ P〈0.05）. The TO and TS value in SAP group and normal group had no significant difference（ P 〉0. 05）. The TO and TS value in acute Myocardial Infarction（AMI） patients and UAP patients in ACS group had no significant difference （0.17 ±1.39）% vs （0.13 ±1.28） %, （3.01±2.16） ms/RR vs （3.47±2.21） ms/RR（ P 〉0.05）. In 6 to 48 months＇ follow-up of ACS patients, the incidence of complex cardiac events in HRT abnormal subgroup was significantly higher than that in HRT normal subgroup （44.44%vs 15.79%） （ P〈0.05）. Conclusion HRT is significantly abated in ACS patients. HRT can be used as an independent clinical predictor of automatic nervous system and cardiac events in ACS patients.

关 键 词：冠状动脉疾病 心肌梗塞 心率震荡 

分 类 号：R541.4[医药卫生—心血管疾病]