急性心肌梗死患者心率变异的观察及敏感指标的探讨  

Observation of heart rate variability in patients with acute myocardial infarction and detection of its sensitive index

作　　者：张颖[1] 杨智昉[2] 王巍[3] 李慈珍[1] 刘远谋[1] 王红卫[1] 

机构地区：[1]上海交通大学基础医学院生理学教研室,上海200025 [2]上海医药高等专科学校生理学教研室,上海201318 [3]上海交通大学医学院附属瑞金医院老年病科,上海200025

出　　处：《上海交通大学学报（医学版）》2013年第7期975-980,共6页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市卫生局基金(2009045);上海市科委基金(06JC14045)~~

摘　　要：目的观察心肌梗死患者入院即时和治疗前心率变异(HRV)的变化,并分析HRV各参数的敏感性。方法采集正常人(正常对照组)、冠心病患者、急性心肌梗死(AMI)患者以及急性心肌缺血动物模型的心电图,进行短时程HRV分析。结果与正常对照组比较,AMI患者除心率减慢外,其他HRV参数均显著增高,其中反映交感神经兴奋性的窦性心搏RR(N-N)间期的标准差(SDNN)、反映迷走神经张力的相邻RR(N-N)间期差值的标准差(SD of delta NN)、相邻RR(N-N)间期差值>50 ms个数占RR间期总数的百分比(NN50)和poincare散点图短轴参数SD1分别为正常对照组的1.8、2.7、7.5和3.1倍。用垂体后叶素诱发动物产生急性心肌缺血后,HRV的变化也呈类似改变。与正常对照组比较,冠心病患者的HRV各参数减小,其中SDNN和SD of delta NN与正常对照组差异无统计学意义(P>0.05),但SD1则明显减小(P<0.01)。结论 AMI时HRV参数显著增大,慢性稳定型冠心病的HRV参数较正常人减小。用HRV判断自主神经活动变化时,SD1优于其他HRV参数。Objective To observe the heart rate variability （HRV） at admission and before treatment in patients with myocardial infarction. Methods Electrocardiograms were recorded from healthy people, patients with coronary heart disease, patients with acute myocardial infarction and acute experimental isehemia animals, and short-time HRV analysis was performed. Results Except for the heart rate, the other indexes of HRV in patients with acute myocardial infarction were significantly higher than those in healthy people, and SDNN （standard deviation of normal to normal RR intervals, representative of sympathetic tone）, SD of delta NN （ standard deviation of successive differences between adjacent normal cycles）, NN50 （ the percent of time that the difference between adjacent normal RR intervals was greater than 50 ms） and minor axis of poineare plot （SD1） which stood for parasympathetic tone, increased by 1.8, 2.7, 7.5 and 3.1 times respectively compared with healthy people. Those changes were also observed in the animal model with acute myocardial isehemia evoked by hypophysin. In comparison with heahhy people, the HRV indexes of patients with coronary heart disease decreased substantially, although SDNN and SD of delta NN did not change significantly （P 〉 0.05）, SD1 decreased significantly （P 〈 0.01）. Conclusion HRV indexes in patients with acute myocardial infarction would elevate significantly. Compared with healthy people, on the other hand, the patients with chronic coronary heart disease exhibit decreased HRV indexes. In all probability, SDI is more useful in evaluation of the changes in autonomic nervous activities than the other HRV indexes.

关 键 词：心率变异 心电图 急性心肌梗死 急性心肌缺血模型 

分 类 号：R542.22[医药卫生—心血管疾病]