急性心肌梗死患者经皮冠状动脉介入前后窦性心率震荡的研究

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

【目的]探讨急性心肌梗死（AMI）后经皮冠状动脉介入（PCI）治疗前、后患者窦性心率震荡（heartrateturbulence，HRT）指标的变化。【方法】选择经冠状动脉造影证实的AMI患者40例，于PCI前及PCI后2h、12～24h及术后1周进行动态心电图检查，分析HRT变化情况。【结果】AMI患者成功PCI（TIMⅠ-Ⅲ级）术后2h内震荡斜率（TS）值即明显改善（升高）（P〈0．01），而震荡初始（TO）无明显改善（P〉0．05）；术后12～24h及一周后TO及TS较术前、术后2h均有明显改善（P〈0．01），但术后12～24h及一周后HRT差异无显著性（P〉0．05）；AMI后行PCI（TIMI1I级）患者术前、术后HRT差异无显著性（P〉0．05）。【结论】AMI患者成功PCI再灌注（TIMI-Ⅲ级）治疗后可明显改善HRT，提示成功PCI可改善和恢复AMI患者心脏自主神经系统，尤其是迷走神经的抗心律失常保护作用机制。

[Objective] To analyze the changes of heart rate turbulence （HRT） in patients undergoing direct percutaneous coronary intervention after acute myocardial infarction （AMI）. [Methods] Forty patients with AMI confirmed by coronary angiography were selected. The dynamic electrocardiogram before percutaneous coronary intervention （PCI） and within 2h, 12-24h, and I week after PCI were monitored and the changes of HRT were analyzed. [Results] The value of TS onset was significantly improved within 2h after successful PCI （TIMⅠ-Ⅲ ） in patients with AMI （ P d0.01）, and the value of TO had no obvious improvement （ P〉0.05）. Compared with 2h after PCI and before PCI, the values of TO and TS onset in 12~24h and 1 week after PCI （TIMⅠ-Ⅲ） were all improved significantly （ P d0.01）, but there was no significant difference in HRT（ P 〉0.05）. And there was no significant difference in HRT between before and after PCI（TIMⅠ-Ⅲ ） after AMI （ P 〉0.05）. [Conclusion]Successful direct PCI （TIMⅠ-Ⅲ） can significantly improve HRT after AMI （ P 〈0.01）. It indicates that PCI can improve and revive heart autonomic nerve system, especially vagal anti arrhythmia protection integrity.