HRV及QTd在急性心肌梗死早期溶栓治疗中的意义

Effects of Early Thrombolytic Therapy on Heart Rate Variability and QT Dispersio in Patients with Acute Myocardial Infarction

目的研究急性心肌梗死(AMI)早期溶栓治疗中心率变异性(HRV)及溶栓治疗前后QT离散度(QTd)变化的意义,并探讨HRV与QTd的相关性。方法对AMI患者早期溶栓再通组、未通组及AMI未溶栓组在起病14d后行24h动态心电图检查及心率变异性(HRV)分析,同时对所有组别进行治疗前后QTd变化对比,观察QTd与HRV的相关性。结果溶检成功组HRV时域分析指标及频域分析指标较溶栓失败组和非溶栓组均显著提高(P<0.01),溶栓失败组与非溶栓组所有HRV分析指标差异均无统计学意义(P>0.05)。溶检成功组、溶栓失败组与非溶栓组的QTd在治疗前均明显增大,在治疗后溶检成功组QTd显著减小(P<0.01),而溶栓失败组与非溶栓组QTd恢复速度显著慢于溶栓成功组,HRV与QTd在急性心肌梗死(AMI)早期溶栓治疗中有显著相关性。结论急性心肌梗死早期溶栓能显著提高患者HRV,显著减小QTd,改善心肌电稳定性及自主神经功能,减少致命性心律失常等事件的发生,从而改善急性心肌梗死患者的预后。

Objective To assess the effects of early thrombolytic therapy on heart rate variability（HRV）and QT dispersio（QTd）in patients with acute myocardial infarction（AMI）. Methods The AMI patients with a first Q wave who met the criteria of HRV measurement were divided into three groups：the successful thrombolytic therapy group,the non-succesaful thrumbolytic therapy group,and the non-thrombolytic therapy group. All subjects received 24-hour ambulatory electro-cardiogram （Hoher） and HRV analysis within two weeks after onset of AMI, The QTd was measured before and after thrombolytic therapy and the results were compared in all the groups. Results Total power frequency （TF）,low power frequency（LF）and high power frequency（HF）in the successful thrombolytic therapy group were significantly higher than those in the non-successfal thrombolytic therapy group and in the non-thrombolytict herapy group（P〈0.01 ）. The ratio of LF/HF in the successful thrombolytic therapy group was significantly lower than those in non-successful thrombolytic therapy group and the non-thrombolytic group （P〈0.01）;The QTd was significantly decreased in the successful thrombolytic therapy group（P〈0.01 ）. There was a significant difference between the non-successful thrombolytic therapy group and the non-thrombolytic group （P^O.05）. Conclusion Successful early thrombolytic therapy can improve HRV and decreased the QTd significantly in patients with AMI, suggesting that the early revascularization of infarct-related artery in AMI improves myocardial electrical stability and the prognosis and decreases the incidence of arrhythmia.