心肌梗塞患者24小时和短期节段性心率变异分析

Analysis of 24hour and short period heart rate variability in patients with acute myocardial infarction

目的：探讨心肌梗塞（ＭＩ）后心率变异（ＨＲＶ）的特点，昼夜节律变化的规律及其临床意义。方法：采用动态心电图（ＡＥＣＧ）技术连续观察了２８例急性心肌梗塞（ＡＭＩ）患者（平均１１天）、３２例陈旧性心肌梗塞（ＯＭＩ）患者（平均８１天）及３６例正常人的ＨＲＶ多项时域指标。结果：ＨＲＶ在ＡＭＩ患者明显缩小，在ＯＭＩ患者已基本恢复，但仍低于正常人。如以ＨＲＶ＜５０ｍｓ为异常，ＡＭＩ、ＯＭＩ及正常人３组的阳性率分别为４２．９％、６．２％和０。与未发生严重心律失常者比较，ＯＭＩ组发生严重心律失常者ＨＲＶ减小。ＡＭＩ患者ＨＲＶ昼夜节律被破坏。结论：对于预测心肌梗塞患者的预后，２４小时ＨＲＶ分析较之短期节段性ＨＲＶ分析具有更大价值。

Objective:To investigate characteristics of heart rate variability (HRV) and circadian rhythm in patients with acute myocardial infarction(AMI) and its clinical significance.Methods:Using an ambulatory electrocardiography,the time domain measurements of HRV were prospectively studied in 28 patients with AMI,32 patients with old myocardial infarction (OMI) and 36 healthy volunteers.Results:HRV in patients with AMI was significantly lower than that in normal controls.HRV in most patients with OMI was obviously improved,but it was still low as compared with controls.The incidences of abnormal HRV (<50 ms) were 42 9%,6 2%,and 0 in patients with AMI,OMI and normal controls respectively.In comparison with patients who did not develop severe arrhythmia,HRV in OMI patients with severe arrhythmia was markedly lowered.In addition,the circadian rhythm of HRV was in disorder in patients with AMI.Conclusions:Analysis of HRV from 24hour electrocardiogram may be of more clinical significance than that from short period to predict prognosis in patients with myocardial infarction.