急性心肌梗塞患者同时检测窦性心率震荡与心率变异性的临床意义  

Clinical significance of simultaneously detecting sinus heart rate turbulence and heart rate variability in patients with acute myocardial infarction

作　　者：资新爱[1] 范咏梅[1] 陈友桂[1] 彭玲湘[1] 

机构地区：[1]湖南省马王堆医院功能科,湖南长沙410016

出　　处：《心血管康复医学杂志》2011年第3期271-274,共4页Chinese Journal of Cardiovascular Rehabilitation Medicine

摘　　要：目的:探讨急性心肌梗塞(AMI)患者同时检测窦性心率震荡(HRT)和心率变异性(HRV)的临床意义。方法:选择78例AMI患者,根据室性早搏Lown分级AMI患者被分为高危组(41例)和低危组(37例);另选择无心血管疾病者61例为正常对照组。所有入选者均行24h动态心电图检查,测定HRT参数震荡初始(TO)、震荡斜率(TS)及HRV参数24h正常RR间期标准差(SDNN)、相邻正常RR间期差值>50ms的心搏数占总RR间期数的百分比(PNN50)。结果:与正常对照组比较,AMI患者HRT明显减弱,HRV明显降低,两组参数有显著差异(P均<0.01);与AMI低危组比较,高危组的TO明显升高[(0.35±3.10)%∶(0.72±2.61)%];SDNN[(93.35±33.21)ms∶(58.21±37.63)ms]、左室射血分数[(60.53±12.74)%∶(46.55±13.41)%]、TS[(3.75±2.20)ms/R-R∶(2.10±3.10)ms/R-R]明显降低(P均<0.05),死亡率明显升高(10.81%∶36.59%,P<0.01);PNN50降低,两组差异无显著性(P>0.05)。结论:窦性心率震荡和心率变异性可作为急性心肌梗塞患者危险分层和判断预后的指标,二者同时检测对于高危患者的干预治疗有重要临床意义。Objective：To explore the clinical significance of simultaneously detecting sinus heart rate turbulence（HRT） and heart rate variability（HRV） in patients with acute myocardial infarction（AMI）.Methods：A total of 78 AMI patients were divided into high risk group（n=41） and low risk group（n=37） according to Lown classification of premature ventricular contraction,and another 61 cases without cardiovascular diseases were enrolled as control group.All subjects received 24h dynamic electrocardiogram and were measured for parameters of HRT [turbulence onset（TO） and turbulence slope（TS）] and parameters of HRV,including standard deviation of normal R-R intervals calculated over the 24h period（SDNN） and PNN50.Results： Compared with control group,HRT significantly weakened and HRV significantly decreased in AMI patients（P0.01 all）;compared with low risk group,TO [（0.35±3.10）% vs.（0.72±2.61）%] significantly increased,SDNN [（93.35±33.21）ms vs.（58.21±37.63） ms],left ventricular ejection fraction [（60.53±12.74） % vs.（46.55±13.41） %] and TS [（3.75±2.20） ms/R-R vs.（2.10±3.10） ms/R-R] significantly decreased（P0.05 all） and mortality（10.81% vs.36.59%,P0.01） significantly increased in AMI high risk group;PNN50 decreased without significant difference between two groups（P0.05）.Conclusion： Sinus heart rate turbulence and heart rate variability could be regard as indexes for risk classification and judgment of prognosis for patients with acute myocardial infarction.Detection of both has important clinical significance in detecting high risk patients for interventional therapy.

关 键 词：心肌梗塞 心率 心电描记术 便携式 

分 类 号：R542.22[医药卫生—心血管疾病]