冠心病患者窦性心率震荡及冠状动脉成形术对其影响

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

目的分析冠心病患者窦性心率震荡(HRT)与冠状动脉病变程度的相关性,探讨急性心肌梗死(AMI)患者急诊经皮冠状动脉成形术(PCI)对HRT的影响。方法冠状动脉造影证实的冠心病患者141例,其中稳定型心绞痛患者35例(SAP组)、不稳定型心绞痛患者28例(UAP组)、急性心肌梗死急诊PCI患者40例(AMI急诊PCI组)、急性心肌梗死未行急诊PCI患者38例(AMI对照组)和无器质性心脏病的室性期前收缩患者30例(对照组)。测定HRT指标[震荡起始(TO)及震荡斜率(TS)],分析HRT与冠状动脉Gensini积分的相关性。结果冠心病患者各组TO值均高于对照组[TO,SAP:(-4.17±2.75)%、UAP:(-3.16±3.18)%、AMI+PCI:(-0.96±2.92)%比对照组(-6.30±3.47)%,均P<0.05],TS值低于对照组[TS,SAP:(6.81±3.18)、UAP:(5.12±3.31)、AMI+PCI:(3.20±1.71)比对照组(9.52±3.85)ms/RR,P<0.05];AMI+PCI组与SAP组、UAP组之间TO、TS值差异均有统计学意义(P<0.05);冠心病患者TO值与Gensini积分呈正相关(r=0.36,P<0.01),TS值与Gensini积分呈中度负相关(r=-0.45,P<0.01);AMI急诊PCI组术后2hTS值明显升高[(4.46±1.69)vs(3.16±1.75)ms/RR,P<0.05],术后24h时TO值及TS值较术后2h有明显改善[TO:24h(-2.63±2.51)%比术后2h(-1.32±2.91)%,TS:24h(5.28±1.59)%比术后2h(4.46±1.69)%,均P<0.01]。结论冠心病患者HRT现象变钝;TO值与冠状动脉病变程度呈正相关,TS值呈中度负相关;急诊PCI术早期可恢复AMI患者心脏自主神经系统。

Objective To investigate the changes of heart rate turbulence （HRT} in coronary heart disease （CHD） and after emergent percutaneous coronary intervention （PCI） in acute myocardial infarction （AMI}. Methods All 141 patients with CHD were confirmed by coronary angiography： stable angina pectoris （SAP; n= 35 ）, unstable angina pectoris （ UAP, n= 28 ）, AMI undergoing emergent PCI （ AMI＋PCI, n= 40 ）, AMI with- out emergent PCI （AMI control, n= 38）, with healthy subjects {n= 30） as control. HRT （TO and TS） was calcu- lated. Results TO onset in the CHD was higher than that of control group [TO, SAP： （-4.17 ±2.75）%, UAP： （-3.16±3.18）%, AMI＋PCI： （--0.96±2.92）% vs AMI control：（ --6.30±3.47）%, P〈0.05], while TS of CHD was significant lower than that of control group [TS, SAP： （6.81±3.18）, UAP： （5.12±3.31}, AMI ＋PCI： {3.20±1.71） vs AMI control： （9.52±3.85）ms/RR, P〈0. 05]. TO was positively moderately correlated with Gensinies score （r= 0.36, P〈0.01）, while the TS was negatively correlated with Gensinies score （r= -0.45, P〈0.01）. Within 2 h after PCI, TS was successfully restored in AMI group [（4.46±1.69） vs onset AMI （3.16±1.75）ms/RR, P〈0. 05]. TO and TS were improved significantly in 24 h after successful PCI [TO, 24 h after PCI： { - 2.63 ± 2.51 ） %vs 2 h after PCI： （ -- 1.32±2.91 ） %, TS, 24 h after PCI ： （ 5.28 ± 1.59 ） % vs 2 h after PCI： （4.46± 1.69）%, both P〈0.01]. Conclusion HRT is blunted and the value of TO and TS was positively correlated with Gensini score in patients with CHD. Emergent PCI improve and restore heart autonomic nerve system in patients with AMI.