急性心肌梗死后心脏自主神经功能的动态变化及恢复

Clinical analysis of cardiac autonomic nervous function after acute myocardial infarction

目的:应用动态心电图(holter)的心率变异(heart rate variability,HRV)及心率震荡(heart rateturbulence,HRT)指标评价急性心肌梗死患者(acute myocardial infarction,AMI)发病15d内、3月时自主神经功能(HRV和HRT)的动态变化,探讨冠脉血运重建治疗对自主神经功能恢复的影响。方法:对入选的40例无严重并发症的AMI患者根据冠脉血运重建情况分为血运重建组和非血运重建组,分别在发病15d内(6～10d),3月时作Holter,分析HRV和HRT。结果:两组内比较,非血运重建组AMI 15d内TO、TS及SDNN均降低,这些指标在AMI后3个月时比15d时有显著性增高(P<0.05)。LF/HF在3个月时才明显恢复,与15d时差异无统计学意义(P>0.05)。血运重建组15d内TS在AMI后15d内明显恢复,与AMI后3月时的TS差异无统计学意义(P>0.05),而TO及SDNN在AMI后3月才有明显恢复,与AMI 10d时比较差异有统计学意义(P<0.05)。LF/HF在3个月时才明显恢复,与15d时差异无统计学意义(P>0.05)。两组间比较,AMI15d内比较HRV和HRT指标,只有TS差异有统计学意义(P<0.05)。两组在AMI3个月时比较HRV和HRT指标,差异无统计学意义(P>0.05)。结论:应用动态心电图可以监测AMI后患者HRT和HRV的动态变化,成功的冠脉血运重建治疗可以使反应压力感受器敏感性的HRT在短时间内很快得到恢复,但对HRV却无明显影响。

Objective： To evaluate cardiac autonomic nervous function by Holter 15 days and 3 months after acute myocardial infarction （AMI）, respectively. Methods： According to the condition of revascularization, 40 patients were divided into two groups： coronary revascularization group and non coronary revascularization group. Cardiac autonomic nervous function, heart rate variability （HRV） and heart rate turbulence （HRT） were determined and compared 15 days and 3 months after AMI. Results- In the non-coronary revascularization group, the TO, TS and SDNN decreased and these index were significantly increased 3 months after AM1 （P〈0.05）. LF/HF was restored 3 months later, but no significantly difference between 15 days and 3 months（P〉0.05）. In the coronary revascularization group, TS was restored 15 days later, but no significantly difference between 15 days and 3 months（P〉0.05）. TO and SDNN were restored 3 months later, and significantly better compared with that at day 15 d （P%0.05）. LF/HF was restored 3 months later, but no significantly difference between 15 days and 3 months（P〉0.05）. 15 days after AMI, there was significant difference in TS between two groups（P〈0.05）, wile no significant difference in HRT and HRV 3 months later （P〉0. 05）. Oonclusion： Hoher can monitor the dynamic change of HRV and HRT after AMI. HRT can be significantly improved by successful reperfusion,but there is no impact on HRV.