溶栓治疗对急性心肌梗塞早期心脏自主神经功能的影响

Effect of Thrombolytic Therapy on Autonomous Function in Early Stage of the Onset of Acute Myocardial

目的研究溶栓治疗对急性心肌梗塞（ＡＭＩ）早期心脏自主神经功能的影响。方法采用时域法研究ＡＭＩ溶栓治疗再通组、未通组、及ＡＭＩ未作溶栓治疗的对照组患者心梗后２４小时内的心率变异性（ＨＲＶ）。结果溶栓再通组２４小时全部窦性ＲＲ间期（ＮＮ）均值的标准差（ＳＤＮＮ）、２４小时所有５分钟窦性ＲＲ间期均值的标准差（ＳＤＡＮＮ）、２４小时相邻窦性ＲＲ间期标准差的平方根（ｒＭＳＳＤ）、逐次的窦性ＲＲ间期改变＞５０ｍｓ的百分比（ＰＮＮ_５０）较溶栓未再通组及对照组均显著提高（Ｐ＜０． ０１）；溶栓未再通组 ＳＤＮＮ、 ＳＤＡＮＮ、ｒＭＳＳＤ、 ＰＮＮ５０与对照组比较无明显差异（Ｐ＞０．０５）。结论溶栓再通灌注能显著提高ＡＭＩ患者早期ＨＲＶ、改善心脏自主神经的功能。

Objective: To investigate the effect of thrombolytic therapy on autonomous function within 24 hours of the onset of acute myocardial infarction Methods: Time domain analysis of heart rate variablity studied in patients showed evidence of reperfusion and that who failed to reper fuse treated with rt-PA intravenous thrombolytic therapy and those as compared group who were not thrombolyzed. Results: Patients with evidence of reperfusion had significantly higher SD of all normal RR intervals in the entire 24-hour recording (SDNN), SD of the mean of all 5 minute segments of normal RR intervals in a 24-hour recording (SDANN),the square root of the mean of the sum of the squares of differences between adjacent RR intervals differing by >50ms (PNN50) comparing with patients failed to reper fuse and those who were not thrombolyzed (P<0. 01), the HRV measurement in patients failed to repterfuse were similar to those obtained in patients with AMI who were not thrombolyzed (P>0.05). Conclusion: Successful reperfusion after rt-PA intravenous thrombolytic therapy significantly increcsed HRV and had a great beneficial effect on autonomous function following acute myocardial infarction.