急性心肌梗死后半年内心率变异的动态演变

Dynamic evolution of heart rate variability in 6 months after acute myocardial infarction.

目的探讨急性心肌梗死（ＡＭＩ）后半年内心率变异（ＨＲＶ）的动态演变规律及其远期预测意义。方法１６例ＡＭＩ患者，于急性期连续记录７２小时动态心电图（ＤＣＧ）。追踪梗死（ＭＩ）后１４天、３０天、（６３±５）天、（１０４±６）天、（１４３±８）天、（１７８±９）天的ＤＣＧ。健康对照组１６例，年龄、性别与ＡＭＩ患者相匹配。ＨＲＶ时域分析指标为：正常Ｒ－Ｒ间期标准差（ＳＤＮＮ）、连续５分钟正常Ｒ－Ｒ间期标准差的均值（ＳＤＡＮＮ）、相邻正常Ｒ－Ｒ间期差值的均方根（ｒＭＳＳＤ）。结果ＭＩ急性期ｒＭＳＳＤ持续下降时间最长，下降幅度最大（下降达５５９８％，Ｐ＜００５）。ＳＤＮＮ、ＳＤＡＮＮ二指标恢复最早，约ＭＩ后６５天恢复至对照组水平［（１２５４４±３７．０８）ｍｓ；（１１４．５６±３７．５９）ｍｓ，Ｐ＞００５］。约１３５天达前半年峰值水平［（１３４．４３±４１．７０）ｍｓ；（１２２．５７±４０．０６）ｍｓ］。ｒＭＳＳＤ至ＭＩ后约１３５天达前半年峰值水平［（２７．５０±９．７０）ｍｓ］，但仍低于对照值（Ｐ＜００５）。至ＭＩ后半年，三项指标昼夜节律均未恢复。２例再梗死患者，猝死发生于ＭＩ后约６５天、１００天。结论ＡＭ?

Objective\ To inquire into the rule of HRV dynamic evolution in 6 months after AMI and its prognostic implication. Methods\ 16 AMI patients' continuous 72-hour DCG were recorded in the AMI-acute period.Their DCG were tracked on the 14th,30th,(635)th,(1046)th,(1438)th,(1789)th day after MI respectively.The age and gender of 16 healthy persons in the controled group match those of the 16 AMI patients.The indicators of HRV time domain analysis are SDNN,SDANN,rMSSD. Results\ The rMSSD in the MI-acute period descended continuously with the longest time and the largest amplitude (by 55.98%,P<0.05).The SDNN and SDANN recovered the earliest,returning to the levels of the controled group 4.5637.59)ms,P>0.05]till the 65th day or so after MI.They reached their peak values of the ealier 6 months of the year till the 135th day or so after MI.The rMSSD reached its peak value of the ealier 6 months of the year(27.509.70ms) till the 135th day or so after MI,but it was still under the control value(P<0.05).The circadian rhythms of the three indicators didn't return to normal over 6 months after MI.2 relapsed cases of sudden death happened on the 65th day and 100th day after MI. Conclusion\ The recovery speed and level of the autonomic nervous function is related to the forward death rate.