阿替洛尔和依那普利对心肌梗死患者心率变异的影响

Influences of atenolol and enalapril on heart rate variability in the patients with myocardial infarction

目的观察阿替洛尔和依那普利对心肌梗死患者心率变异的影响,分析药物对自主神经功能的影响。方法急性心肌梗死患者出院前随机分成阿替洛尔组、依那普利组和对照组三个治疗组,出院前、出院后半年和出院后1年检查动态心电图,分析心率变异。结果入选急性心肌梗死患者49例,年龄33～75(均61)岁,男性32例,女性16例。出院时随机分为阿替洛尔组16例,依那普利组17例,治疗对照组16例。心肌梗死半年和心肌梗死后1年,阿替洛尔组和依那普利组患者的心率变异均大于治疗对照组(P<0.05),两个药物治疗组间差异无统计学意义(P>0.05)。心肌梗死发病3周、6个月和12个月,随时间推移心率变异逐渐增大,心肌梗死发病6个月较发病3周时的心率变异显著增大(P<0.05),发病12个月时心率变异多项参数虽有增大趋势,但无统计学意义。心肌梗死发病不同时期的患者,心率变异显著小于正常对照组(50例,P<0.01)。结论急性心肌梗死患者使用阿替洛尔和依那普利1年,心率变异持续得到改善。

Objective To analyze the effect of atenolol and enalapril on patients with acute myocardial infarction （AMI） in order to displaying the effect of medicine on the function of autonomous nervous system. Methods The patients with AMI were randomizedly divided into three groups, atenolol group, enalapril group, and treatment control group. Holter and heart rate variability （HRV） for these patients were recorded and analyzed before discharge, in half year, and in one year after discharge, Results Forty-nine cases with AMI were included in the study, age 33 to 75 years old, 32 men and 16 women. There were 16 AMI cases in atenolol group, 17 cases in enalapril group, 16 cases in treatment control group. The HRV of the AMI patients in the atenolol and enalapril group were greater than that in the treatment control group（P〈0.05）, and there was no difference between the patients in atenolol group and enalapril group （P〉0.05）. The HRV parameters were improved in half year and one year gradually compared to those in the patients before discharge （P〈0.05）. The HRV parameters of all the patients in the acute phase, half year, or one year after the onset of AMI were smaller than those in the normal controls. Conclusion Atenolol and enalapril are useful to improve the HRV of the AMI patients.