长程与短程心率变异性的结合对于急性心肌梗死患者预后的意义  

Long-term and short-term heart rate varlabillty measurement in patients with acute myocardial infarction

作　　者：权薇薇[1] 戚文航[1] 刘霞[1] 张娟赢[1] 杨丽英[1] 

机构地区：[1]上海第二医科大学附属瑞金医院心内科,200025

出　　处：《临床心电学杂志》2000年第4期199-202,共4页Journal of Clinical Electrocardiology

摘　　要：目的　比较长程与短程心率变异性 (HRV)分析对于急性心肌梗死 (AMI)患者预后的不同预测价值。方法　选择 1995年 10月至 1996年 12月入我院的 AMI患者 5 0例 ,结合时域与频域的方法 ,分别进行长程 (2 4小时 ) ,短程 (1- 3小时 )分析。结果　长程短程 HRV分析相关性很强 ,相关系数在0 .74～ 0 .98之间。不论长程分析还是短程分析 HRV,在 6个月随访死亡病例中均降低 ,除高频 (HF) ,低高频比值 (L F/ HF)外其余各项 HRV指标均降低达统计学显著意义。选择 15 % HRV最低的患者作为观察对象 (2 4小时 SDNN <5 0 ms,1小时 SDNN <2 0 m s) ,短程 HRV分析预测半年死亡率明显低于长程HRV分析 (P<0 .0 5 ) ,当逐渐增加短程 HRV分析中低 HRV人群所占百分比时 (30 % ,1小时 SDNN<30 m s) ,其预测价值接近于长程 HRV的预测价值。结论　通过短程 HRV分析预选出一批高危患者有利于临床更快更早期地对 AMI患者进行危险度分层 ,及早采取干预措施。Objective Compare the positive accuracy between short-term(1～3hrs) and long-term (24hrs) heart rate variability (HRV) measurement in patients with acute myocardial infarction(AMI).Methods 50 patients with AMI using both time and frequency domain methods of HRV to do short and long-term HRV analysis.Results The correlation between short-and long-term values were very strong(r:0.74～0.98).During the six months follow-up,patients who died showed a significently lower HRV(except HF and LF/HF) in both assessments.We used 15% of the patients with lowest HRV (24-hour SDNN<50ms,1-hour SDNN<20ms) as a criteria to compare the positive predictive accuracy betwen 24-hour HRV and 1-hour HRV,finding that the positive predictive accuracy of 24-hour HRV was clearly superior to 1-hour HRV( P <0 05).Increased the ratio of patients with lowest HRV(30% 1-hour SDNN<30ms),the predictive value was almost similar to the long-term HRV assessed in all patients.Conclution The data suggest that it might be possible to identify high risk patients after AMI by using short-term HRV assessment to preselect.This approach would provide a quick and time-effective method for an risk statification in patients after AMI.

关 键 词：心肌梗死 心率变异性 急性 预后 

分 类 号：R542.220.7[医药卫生—心血管疾病]