24h动态心电图参数对急性心肌梗死患者恶性室性心律失常的指导意义研究  

The Guiding Significance of 24-h Holter ECG Parameters in Malignant Ventricular Arrhythmia in Patients with Acute Myocardial Infarction

作　　者：李莹莹 LI Ying-ying(Emergency Department,Jiujiang First People's Hospital,Jiujiang 332000,Jiangxi Province,China)

机构地区：[1]九江市第一人民医院急诊科,江西九江332000

出　　处：《罕少疾病杂志》2024年第10期43-45,共3页Journal of Rare and Uncommon Diseases

摘　　要：目的探讨24h动态心电图参数对急性心肌梗死(AMI)恶性室性心律失常(MVA)的指导意义。方法选取本院急性心肌梗死(AMI组)和体检体检者(对照组)各90例,样本纳入启动时间为2020.04,结束于2022.04。再将AMI组患者根据有无MVA进行分组,均接受24h动态心电图检查,监测心率变异性(HRV)、QT间期的变异性(QTV)指标,分析24h动态心电图参数预测AMI患者MVA发生的效能。结果AMI组经24h动态心电图获取的SDNN、SDNN-index、SDANNindex、rMSSD、24h-QTV、Day-QTV、Night-QTV数值均低于对照组(P<0.05);AMI组90例患者经治疗评估后,32例发生MVA,其余则未发生。MVA组经24h动态心电图获取的SDNN、SDNN-index、SDANN-index、24h-QTV、Day-QTV、Night-QTV数值均低于非MVA组,且两组在心功能Killip分级和低血钾指标上出现明显差异(P<0.05),但两组rMSSD数值比较未发现统计学差异(P>0.05);经Logistic回归分析显示,Killip分级和低血钾和24h动态心电图参数在预测AMI患者MVA发生均有意义(P均<0.05),尤其是上述联合预测AMI患者MVA发生的ROC曲线下面积最大,诊断效能最高。结论24 h动态心电图参数中HRV和QTV是预测MVA非常有价值的指标,将对后续诊断治疗起到重要的指导意义。Objective To explore the significance of 24h dynamic ter parameters for malignant ventricular arrhythmia(MVA)in patients with acute myocardial infarction(AMI).Methods 90 cases of acute myocardial infarction(AMI group)and 90 healthy volunteers(control group)were included in the study,and the sample was started in 2020.04 and ended in 2022.04.Patients in the AMI group were grouped according to the presence of MVA,and all selected patients were examined for 24h after admission to monitor heart rate variability(HRV)and QT interval variability(QTV)index,and evaluate the efficacy of AMI patients to predict the occurrence of MVA using working characteristic curve(ROC).Results The values of SDNN,SDNN-index,SDANN-index,rMSSD,24h-QTV,Day-QTV and Night-QTV obtained at 24h were lower than those of the control group(P<0.05);in 90 patients of AMI group,32 experienced MVA after treatment evaluation,while the rest were not.The values of SDNN,SDNN-index,SDANN-index,24h-QTV,Day-QTV,and Night-QTV obtained in the MVA group were lower than those of the non-MVA group,Moreover,the two groups showed significant differences in the Killip grade and hypokalaemia index of cardiac function(P<0.05),However,no statistical difference was found between the two groups(P>0.05);As shown by the Logistic regression analysis,Killip Grade and hypokalaemia and 24h Holter ECG parameters were significant in predicting the occurrence of MVA in AMI patients(P<0.05),in particular,the largest ROC area under the curve the above jointly predicted MVA occurrence in AMI patients,The highest diagnostic efficacy was observed.Conclusion HRV and QRV in 24 h Holter ECG parameters are very valuable indicators to predict MVA and will be important guidance for subsequent diagnosis and treatment.

关 键 词：24h动态心电图参数 急性心肌梗死 恶性室性心律失常 心率变异性 

分 类 号：R542.22[医药卫生—心血管疾病]