心率变异性与急性心肌梗死部位的临床分析  

Clinical observation of heart rate variability and the sites of acute myocardial infarction

作　　者：沈国英[1] 金智敏[1] 

机构地区：[1]上海市松江区中心医院心内科,上海201600

出　　处：《重庆医科大学学报》2014年第10期1410-1413,共4页Journal of Chongqing Medical University

摘　　要：目的:观察心率变异性(heart rate variability,HRV)与不同部位的急性心肌梗死(acute myocardial infarction,AMI)关系,同时观察HRV与AMI后恶性室性心律失常(malignant ventricular arrhythmia,MVA)的关系。方法:选取我院心内科住院的AMI患者120例,依据AMI后是否发生MVA,分为MVA组和无恶性室性心律失常(non malignant ventricular arrhythmia,NMVA)组;依据心梗部位不同,分为前壁心梗组和非前壁心梗组。分析HRV各项指标的变化。结果:MVA组正常NN间期的标准差(standard deviation of the NN intervals,SDNN)、平均正常NN间期标准差(standard deviation of the average NN intervals,SDANN)、SDNN指数、连续NN间期之差的均方根(square root of the mean squared differences of successive NN intervals,RMSSD)、低频(lowfrequency,LF)、高频(high-frequency,HF)、LF/HF明显低于非前壁心梗组,P值分别为0.000、0.004、0.001、0.000、0.000、0.001与0.017;而极低频(very low-frequency,VLF)2组间无统计学差异(P=0.714)。前壁心梗组正常SDNN(P=0.000)、SDANN(P=0.000)、SDNN指数(P=0.000)、LF(P=0.000)、LF/HF(P=0.013)明显低于非前壁心梗组;RMSSD(P=0.000)、HF(P=0.000)明显高于非前壁心梗组,差异具有统计学意义;VLF2组间无明显差异(P=0.064);前壁心梗组MVA发生率明显高于非前壁心梗组,统计学上有差异(P=0.008)。结论:HRV与AMI后MVA的发生可能存在一定的关系。此外,HRV可能与AMI发生的部位有关,前壁心梗可能以交感神经活动增强为主,非前壁心梗可能以迷走神经活动降低为主。Objective ：To observe the relationship between heart rate variability（HRV） and the sites of acute myocardial infarction（A- MI）, and to observe the relationship between HRV and malignant ventricular arrhythmia（MVA） following AMI. Methods：Totally 120 patients with AMI in our hospital were selected. According to the classification of ventricular arrhythmia, patients was divided into two groups：MVA groups and non MVA（NMVA） groups. According to the infarction parts, patients was also divided into two groups：ante- rior wall infarction and non anterior wall infarction groups. HRV were obtained by the 24h-Hoher. Results ： Standard deviation of the average NN intervals （SDANN）, standard deviation of the average NN intervals （SDANN）, SDNNI, square root of the mean squared differences of successive NN intervals （RMSSD）,low-frequency （LF）, high-frequency （HF） and LF/HF were lower in MVA group than in NMVA group and the P values were 0.000,0.004,0.001,0.000,0.000,0.001 and 0.017, respectively. But there was no difference between the two groups in very low-frequency （VLF） （ P=0.714 ）. Values of SDNN （ P=0.000 ）, SDANN （P=0.000）, SDNNI （P=0.000）, LF（P=0.000） ,LF/HF（P=0.013） were lower in anterior wall infarction group than in non anterior wall infarction groups. RMSSD（P= 0.000） and HF（P=0.000） values were higher in anterior wall infarction group than in non anterior wall infarction group. And there was no difference between the two groups in VLF（P=0.064）. Conclusion：HRV is correlated with MVA following AMI. HRV might correlate with the site of myocardial infarction. Anterior wall infarction may be led by the increased sympathetic nervous activity, while non anterior wall infarction may be led by the decreased vagal activity.

关 键 词：急性心肌梗死 心率变异性 恶性室性心律失常 

分 类 号：R541.7[医药卫生—心血管疾病]