心肌梗死后心率变异性、压力反射敏感性与心肌电生理特性的关系  

The correlation between heart rate variability, baroreflex sensitivity and cardiac electrophysiologic characteristics after myocardial infarction

作　　者：张燕[1] 张旭明[1] 伍卫[1] 聂如琼[1] 方昶[1] 周淑娴[1] 陈筱潮[1] 

机构地区：[1]中山医科大学孙逸仙纪念医院内科心电生理室,广州510120

出　　处：《中华心血管病杂志》2000年第3期224-227,共4页Chinese Journal of Cardiology

摘　　要：目的　探讨心率变异性 (HRV)、压力反射敏感性 (BRS)预测心肌梗死 (心梗 )后心脏性猝死的电生理基础。方法　 48只心梗兔分别测量HRV时域与频域指标、BRS、心室有效不应期离散性(VERP D)、室颤阈值 (VFT) ,各指标进行相关性分析。结果　根据电刺激能否诱发心室颤动 (室颤 )分为室颤组 (n =2 5 )和无室颤组 (n =2 3) ,室颤组的心率变异系数、极低频、低频、高频、BRS和VFT明显降低 ,VERP D明显增加。相关性分析显示 ,HRV与BRS呈弱的正相关性。HRV、BRS与VERP D呈负相关、与VFT呈正相关 ,BRS与VERP D、VFT的相关性较HRV更强。结论　HRV不能替代BRS ,BRS与心肌电稳定性的关系更为密切 。Objective To investigate the electrophysiological basis for prediction of the sudden cardiac death (SCD) by applying heart rate variability (HRV) and baroreflex sensitivity (BRS) after myocardial infarction (MI). Methods Time and power domain parameters of HRV, BRS, the dispersion of ventricular effective refractory period (VEBR D) and ventricular fibrillation threshold (VFT) were measured sequentially in forty eight rabbits with MI. The correlation between parameters was analyzed. Results According to the inducibility of ventricular fibrillation (VF) by electric stimuli, the rabbits were divided into two groups: VF group ( n = 25) and non VF group ( n = 23). Compared with those of non VF group, CV, VLF, LF, HF, BRS and VFT of VF group were decreased ( P< 0 05, P< 0 01), VERP D was increased. There was a weak positive correlation between HRV and BRS ( r =0 30-0 49, P< 0 05, P< 0 01). CV, VLF, LF and HF were negatively correlated with VERP D ( r =-0 30- -0 49, P< 0 05, P< 0 01), and positively correlated with VFT ( r =0 30-0 41, P< 0 05, P< 0 01). BRS had a negative correlation with VERP D ( r =-0 68, P< 0 01), and a positive correlation with VFT ( r =0 71, P< 0 01). The correlation between BRS and VERP D, VFT was comparatively stronger than that between HRV and VERP D, VFT. Conclusion BRS may not be replaced by HRV. BRS has a stronger correlation with the electric stability of myocardial infarction. It is suggested that BRS may provide a more accurate risk stratification than HRV for SCD after MI.

关 键 词：心肌梗塞 电生理学 心率变异性 压力反射敏感性 

分 类 号：R542.22[医药卫生—心血管疾病]