心肌梗死患者搭桥术后窦性心率震荡的临床研究

Study of Heart Rate Turbulence after CABG in Post-infarction Patients

目的通过对心肌梗死患者冠脉搭桥术后进行窦性心率震荡(HRT)的检测及结果分析,评价HRT对心梗患者冠脉搭桥术后死亡率的预测价值。方法40例心梗患者搭桥术后和23例正常人分为心梗组和对照组;其中心梗组按检测结果再分为:震荡初始(TO)、震荡斜率(TS)2项阳性组、TO或TS1项阳性组和阴性组。选用美高仪公司生产的带有HRT检测功能的数字动态心电记录器,对入组病例行24h动态心电图检查,并用Holter12TopVersion分析软件分析单次室早后窦性心率震荡值TO及TS。随后进行平均6个月的随访。结果①心梗组TO、TS的阳性检测率均高于对照组,(分别为p<0.01和p<0.05);②平均6个月随访结果:心梗组中2项阳性组的3例患者猝死,1项阳性组和阴性组无死亡病例。结论室早后窦性心率震荡是一种对心梗患者冠脉搭桥术后新的有效的猝死高危预测指标。

Objective The aim of this study is to investigate the characteristics of heart rate turbulence after CABG in Chinese post-infarction patients, and to evaluate the prediction value of heart rate turbulence on mortality rate of these patients. Methods Forty patients who received CABG after myocardial infarction(experiment group) and twenty three healthy volunteers(control group) were examined with ambulatory electrocardiogram monitoring for twenty-four hours. Post-infarction patients were classified into 3 subgroups: both TO and TS were normal subgroup, either TO or TS was abnormal subgroup and both TO and TS were abnormal subgroup. The turbulence onset(TO) and turbulence slope(TS) after a ventricular premature contraction was analyzed by Top Version 12 leads Holter analyzing system. All cases had repeated the ambulatory electrocardiogram monitoring test six months later. Results The positive rate of TO and TS in the experiment group was higher(P<0.01, P<0.05) than that in the control group. Three patients died during the 6 months follow-up, while none in the control group. Conclusion TO and TS were both an early high risk prediction factor after CABG in postinfarction patients. [