心率变异预测急性心肌梗死患者预后的临床分析

Clinical analysis of prognostic significance of heart rate variability for patients with acute myocardial infarction

目的探索急性心肌梗死患者心率变异(heart rate variability,HRV)变化及对预后转归判断的临床意义。方法检测132例急性心肌梗死患者症状发生后1周内的HRV指标。按心肌梗死范围,以及有无心脏事件进行比较分析。结果 132例急性心肌梗死患者中发生心脏事件59例,无心脏事件73例;复合性心肌梗死45例,单纯性心肌梗死87例。发生心脏事件患者HRV指标明显低于无心脏事件患者,差异有统计学意义(P<0.001);复合性心肌梗死患者HRV指标明显低于单纯性心肌梗死患者,差异有统计学意义(P<0.001)。结论急性心肌梗死引起自主神经系统功能失衡,诱发心脏电生理紊乱,HRV可较好地反映心肌梗死范围以及有无心脏事件的发生,是判断急性心肌梗死严重程度及预后转归的一个有价值指标,HRV越低,急性心肌梗死患者病情越重,预后越差。

Objective To study the change of heart rate variability （HRV） and its clinical significance for prognosis in patients with acute myocardial infarction （AMI）. Methods The HRV of 132 patients after AMI l week was examined. Association of the HRV with myocardial infarction size and adverse cardiac events were statistically analyzed. Results Of 132 AMI patients, it was found that there were 59 cases had adverse cardiac events. Moreover, there were 45 cases with complex myocardial infarction and 87 cases with simple myocardial infarction. The HRV of patients with adverse cardiac events was significantly lower than that of patients without cardi- ac events （P 〈 0. 001 ）. In addition, the HRV of patients with complex myocardial infarction was significantly lower than that of patients with simple myocardial infarction （ P 〈 0. 001 ）. Conclusions AMI may result in dysfunction of the autonomic nervous system, and then induce cardiac eleetrophysiology disorders. HRV can well reflect myocardial infarct size and adverse cardiac events. Therefore, it is a valuable indicator for evaluating severity and prognosis in patients with AMI. The lower the HRV AMI patients have, the more severe adverse cardiac events as well as the worse prognosis they may suffer.