多项无创指标对急性心肌梗死患者心源性死亡的预警分析  

Predictive value of multiple non-invasive index on cardiac death of patients with acute myocardial infarction

作　　者：李勇国[1] 王艳飞[1] 王玮[1] 

机构地区：[1]昆明市第一人民医院心内科,云南省昆明市650000

出　　处：《中国心血管病研究》2016年第2期137-141,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨多项无创指标对冠心病急性心肌梗死（AMI）患者心源性死亡风险的预警价值。方法入选AMI患者100例为观察组，同期住院的非冠心病患者100例为对照组。收集临床资料，并于入院后3周内行动态心电图（Holter）检查，检测心率震荡（HRT）指标即震荡起始（TO）、震荡斜率（TS）；心率变异性（HRV）指标即NN间期标准差（SDNN）；QT离散度（QTa）及经心率校正的QT离散度（QTcd）心电指标。同期行心脏彩超检查，检测左心室舒张期末径（LVEDd）和左室射血分数（LVEF）。以AMI患者心源性死亡为终点事件，将观察组分为死亡组（n=15）和存活组（n=85）。根据检测结果，对AMI组与非AMI组和AMI患者死亡组与存活组各项指标进行对比分析，评价多项指标对AMI患者心源性死亡的预警价值。结果①AMI组与非冠心病组TO、TS、SDNN、QTd、QTcd、LVEF、LVEDd等各项指标比较差异有统计学意义，其中TO、TS、SDNN、OTd、QTcd、LVEDd P=0．000（P〈0．05），LVEFP=0．002（P〈0．05）。②急性心梗死亡组与存活组TS及SDNN比较差异有统计学意义，P值为0．000及0．023（P〈0．05），TO、QTd、QTcd、LVEF及LVEDd等指标比较未见统计学差异（P〉0．05）。③对各组各项指标阳性积分对比分析发现，AMI患者积分多明显增高（P〈0．05），AMI心源性死亡患者积分均≥4，多项指标联合应用较单项指标对AMI患者心源性死亡的阳性预测值高，多项指标异常积分≥4，心源性死亡风险极大。结论①AMI患者的HRT明显减弱甚至消失，HRV降低，QT间期明显延长及QTd明显增大。②AMI患者LVEDd明显增大，LVEF明显下降。多项指标联合应用对AMI患者心源性死亡的阳性预测值高。Objective Several indicators of the noninvasive tests were used in this study to warn the risk of Cardiac death for the patients. Methods One hundred patients with AMI were selected as AMI group and 100 patients without CHD were selected as control group. The clinical data was collected. Holter was done for all of the patients during their hospitalization to test heart rate turbulence （HRT） for the indicators of shock initiation（TO） and turbulence slope （TS）, heart rate variability （HRV） for the indicator of standard deviation of NN （SDNN） and QT dispersion（QTd） as well as heart rate corrected QT dispersion（QTcd ）. And echo-cardiogram was taken to test the left ventficular end-diastolic dimension （LVEDd） and the left ventficular ejection fraction （LVEF）. The AMI group was subdivided as death sub-group（n=15） and survival sub-group（n=85） according to the final outcome of Cardiac death. The noninvasive test data of each group and sub-group were analyzed contrastively. And the abnormal changes of single indicator and multiple indicators in different group and sub-group were analyzed to evaluate the warning value to cardiac death for the patients of AMI. Results （1）TO, TS, SDNN, QTd, QTcd, LVEDd and LVEF were different significantly （P〈O.05） between AMI group and control group. （2）TO, TS and LVEDd were different significantly （P〈0.05） between death sub-group and survival sub-group. SDNN, QTd, QTcd and LVEF were not different significantly（P〉0.05 ） between the two sub-groups. （3）TS was the most influential factor to the cardiac death by logistic analysis. （4）The abnormal changes of multiple indicators were more frequent in AMI group and the positive rate （%） of the multiple abnormality was significantly higher （P〈0.05） than the control group. （5）The score of the abnormal indicators was significantly higher （P〈0.05） in AMI group, and the score of the dead patients was all ≥4. （6）The warning to risk of cardiac death wi

关 键 词：急性心肌梗死 心源性死亡 心率震荡 心率变异 猝死预测因子 

分 类 号：R542.22[医药卫生—心血管疾病]