心率减速力及连续心率减速力对急性心肌梗死患者猝死的预测价值  

Clinical value of deceleration capacity and heart rate deceleration runs in predicting sudden death of patients with acute myocardial infarction

作　　者：宋旷蓉[1] 冷永群[1] 卢佳佳[1] 张硕[1] 涂婉华[1] 叶静[1] 

机构地区：[1]华中科技大学同济医学院附属武汉市中西医结合医院(武汉市第一医院)心电诊断科,湖北武汉430022

出　　处：《江苏实用心电学杂志》2015年第3期190-193,共4页Journal of Practical Electrocardiology JS

基　　金：武汉市卫计委卫生科技计划项目(2003)228

摘　　要：目的通过心率减速力(deceleration capacity of rate,DC)及连续心率减速力(heart rate deceleration runs,DRs)两项检测技术对急性心肌梗死患者进行风险分层,探讨其预警猝死的临床意义。方法选择经皮冠状动脉造影术(coronary angiography,CAG)确诊为冠心病的心梗患者(AMI组)与冠脉造影正常的健康人群(正常组)各90例进行对比,行24 h动态心电图检查,由系统软件自动分析并计算出DC值及DRs值。结果 AMI组的DC值及DRs值明显下降,与正常组比较,差异有统计学意义(P<0.01);根据病程划分的AMI各亚组与正常组比较,差异有统计学意义,病程超过6个月风险明显下降;同时,DC与DRs提示的风险越高,即提示病情越重,这与冠脉造影对应的病变数量及范围相符。结论心率减速力与连续心率减速力具有定量、单独分析测定迷走神经的功能,两者联合运用对急性心肌梗死高危人群有较高的预警价值。Objective To make risk stratification of patients with acute myocardial infarction( AMI) by detecting deceleration capacity( DC) and heart rate deceleration runs( DRs),and to investigate the clinical significance of the two detection technics in the early warning of cardiac sudden death.Methods Comparative analysis was carried out between 90 AMI patients diagnosed with coronary heart disease by coronary angiography( CAG)( AMI group) and 90 healthy people with normal CAG results( normal group).The two groups underwent 24-hour ambulatory electrocardiography examination while values of DC and DRs were automatically analysed and calculated by software.Results The values of DC and DRs descended significantly in AMI group,and the difference was statistically significant( P < 0.01) if compared with those in normal group.There were statistically significant differences of DC and DRs values between the AMI subgroups divided by the course of the disease and normal group.When the the course of AMI was over 6 months,the risk of cardiac sudden death decreased significantly.Meanwhile,the higher the risk indicated by DC and DRs was,the more severe the disease was,which coincided with the quantity and extent of lesioned vessels byCAG.Conclusion DC and DRs can be utilized to analyze vagus nerve function quantificationally and independently.The combined use of the two parameters is quite valuable in prewarning AMI high-risk group.

关 键 词：急性心肌梗死 心率减速力 连续心率减速力 冠脉造影 心脏猝死 

分 类 号：R542.22[医药卫生—心血管疾病]