溶栓治疗对急性心肌梗死患者窦性心率震荡及心率变异性的影响

Influences of thrombolytic therapy on heart rate turbulence and heart rate variability in patients with acute myocardial infarction

摘要:

目的：观察溶栓治疗对急性心肌梗死（acute myocardial infarction，AMI）患者窦性心率震荡（heart rate turbulence，HRT）及心率变异性（heart rate variability，HRV）的影响。方法：62例ＡＭＩ患者按溶栓治疗后有无血管再通分为再通组（n=38）和未通组（n=24），并选择同期未行溶栓治疗的20例ＡＭＩ患者做对照组。起病后1~2周行动态心电图检查分析反应HRT的指标震荡起始（turbulence onset，TO）及震荡斜率（turbulence slope，TS），及HRV相关指标全部窦性心搏RR间期（NN间期）的标准差（standard diviation of NN intervals，SDNN）、全程相邻NN间期之差的均方根值（root mean square of sussessive differences，RMSSD）及全部NN间期中，相邻的NN间期之差大于50 ms的心搏数除以总的NN间期个数、乘以100（PNN50）。结果：再通组TO值低于未通组及对照组[（-1.54±2.03）% vs. （0.15±2.51）%，（0.21±1.94）%，q=3.71，P=0.006]，而TS、SDNN、RMSSD及PNN50均高于未通组及对照组[分别为（6.89±2.14） ms/RR vs. （2.46±1.90） ms/RR，（2.55±2.38） ms/RR，q=3.64，P=0.008；（118.62±27.13） ms vs. （82.56±30.47） ms，（85.62±27.79） ms，q=4.27，P=0.002；（27.23±9.72） ms vs. （17.03±8.47） ms，（16.72±8.68） ms，q=3.95，P=0.005；（8.64±2.36）% vs. （3.14±1.87）%，（2.96±1.70）%，q=4.73，P=0.001]；溶栓治疗后血管再通与TO值负相关（rs=-0.257，P=0.001），而与TS、SDNN、RMSSD、PNN50正相关（rs分别为0.490、0.273、0.466、0.392，P=0.000）。结论：溶栓治疗成功能改善AMI患者HRT指标并提高HRV，改善AMI患者心脏自主神经功能，可能减少恶性心律失常发生，改善预后。

Abstract:

Objective：To assess the influences of thrombolytic therapy on heart rate turbulence（HRT） and heart rate variability（HRV） in patients with acute myocardial infarction（AMI）. Methods：Sixty-two patients with AMI underwent thrombolytic therapy were di－vided into recanalization group（n=38） and non-recanalization group（n=24） and another 20 AMI patients without recanalization were selected as control group. The 24 h ambulatory electrocardiogram recordings were taken within 1-2 weeks after onset of AMI. HRT pa－rameters，turbulence onset（TO） and turbulence slope（TS） were calculated and HRV analysis was performed using time domain pa－rameters standard diviation of NN intervals（SDNN），root mean square of sussessive differences（RMSSD） and percentage of differ－ences exceeding 50 ms between adjacent normal number of intervals（PNN50）（6.89±2.14） ms/RR vs. （2.46±1.90） ms/RR，（2.55±2.38） ms/RR，q=3.64，P=0.008；（118.62±27.13） ms vs. （82.56±30.47） ms，（85.62±27.79） ms，q=4.27，P=0.002；（27.23±9.72） ms vs. （17.03±8.47） ms，（16.72±8.68） ms，q=3.95，P=0.005；（8.64±2.36）% vs.（3.14±1.87）%，（2.96±1.70）%，q=4.73，P=0.001 respectively）. Results：HRV was markedly reduced while HRT was markedly blunted in non-recanalization group and control group than in recanalization group（P<0.01 for all）. There were correlations between vascular recanalization after recanalization and HRV，HRT parameters（TO：rs=-0.257；TS：rs=-0.490；SDNN：rs=0.273；RMSSD：rs=0.466；PNN50：rs=0.392；P≤0.001 for all）. Conclusions：Successful thrombolytic therapy can improve the parameters of HRV and HRT and protect heart autonomic nervous sys－tem function in patients with AMI so as to improve their prognosis.