急性心肌梗死患者经皮冠状动脉介入后心率震荡的变化

Changes of Heart Rate Turbulence in Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention

目的探讨经皮冠状动脉介入（PCI）治疗急性心肌梗死（AMI）后对窦性心率震荡（HRT）的影响。方法选120例急性心肌梗死患者分为直接PCI组、延迟PCI组和药物治疗组三组，各组均为40例，入选病例均有单发室性期前收缩（VPC）并且有完全的代偿间歇，AMI后1～3周对患者行24h动态心电图检测，获得震荡起始（TD）、震荡斜率（TS）、震荡斜率起始时间（TT）等指标，比较三种治疗方法对急性心肌梗死后窦性心率震荡现象的影响。结果直接PCI组TT、TO低于延迟PCI组和药物治疗组，而TS高于延迟PCI组和药物治疗组（P〈0．01），同时延迟PCI组上述指标也优于药物治疗组（P〈0．05）。结论AMI患者经直接或延迟PCI后HRT各参数得到不同程度改善，直接PCI更优，故对于AMI患者应尽早行直接PCI，对于无条件者行延迟PCI同样获益。

Objective To investigate the effects of percutaneous coronary intervention（PCI）on heart rate turbulence（HRT） after acute myocardial infarction （AMI）. Methods One hundred and twenty patients with AMI were divided into three groups： immediate PCI group（n = 40）, delayed PCI group（ n = 40） and drug treatment group（ n = 40）. All patients had a single ventricular premature contraction（VPC）and complete compensation intermittent. Heart rate turbulence indices including turbulence onset （TO）, turbulence slope （TS）, and turbulence timing （TT） were determined by 24h ambulatory electrocardiograph （Holter） 1 - 3 weeks after AMI. The values of above indices were compared among three groups, then to investigate the changes of HRT in each group. Results The levels of TT and TO in immediate PCI group were significantly lower than those in delayed PCI group and drug treatment group, but TS was higher in immediate PCI group （ P 〈 0.01）. The indices of HRT in delay PCI group were superior to those in drug treatment group （ P 〈 0.05）. Conclusions The treatment of immediate PCI and delayed PCI can significantly improve the parameters of heart rate turbulence in acute myocardial infarction patients. Immediate PCI should be done as soon as possible. The patients with delayed PCI also can get the same benefit if immediate PCI was not permitted.