急性心肌梗死患者连续心率减速力的研究

Clinical study of heart rate deceleration runs in Chinese acute myocardial infarction patients

目的探讨国人急性心肌梗死(AMI)患者连续心率减速力(DRs)的变化及其与心率变异性(HRV)之间的关系。方法 102例AMI患者和100例正常人接受24h动态心电图检查,分别测定两组的DRs值(DR2,DR4,DR8)及HRV时域指标(SDNN,SDANN),比较两组的DRs值,并对AMI患者的DRs与HRV时域指标做相关性分析。结果 AMI组的DR4值明显小于正常组(0.4002%±0.2461%vs.0.7627%±0.3164%,p<0.001);DR8值亦小于正常组(0.0086%vs.0.02%,p<0.001);DR2值则与正常组无明显统计学差异(8.0441%±2.1567%vs.8.3860%±1.7074%,p=0.214)。DRs预测中、高危患者的比例在AMI组为39.2%,明显高于正常组的4%(p<0.001);AMI组的DRs与SDNN、SDANN呈显著正相关(p<0.05)。结论 AMI患者的DR4及DR8值明显降低,与SDNN及SDANN呈正相关,提示DRs可定量评估AMI患者迷走神经张力,或可成为预测国人心梗患者发生猝死的又一新指标应用于临床。

Objective To investigate changes of heart rate deceleration runs（DRs）and correlation DRs with heart rate variability（HRV）in Chinese acute myocardial infarction（AMI）patients;Methods 102 AMI patients and 100 normal subjects underwent 24 hours ambulatory electrocardiogram examination,DRs values（DR2,DR4,DR8）and HRV time domain indices（SDNN,SDANN）were measured,compared with DRs of two groups,and correlation analysis was done with DRs and HRV time domain indices in AMI patients.Results DR4 in AMI group was significantly smaller than that in control group（0.4002 %± 0.2461% vs.0.7627% ± 0.3164%,p 0.001）,DR8 was also smaller than that in control group（0.0086% vs.0.02%,p0.001）,no statistically significant difference was found in DR2 with normal group and AMI group（8.0441%±2.1567% vs.8.3860%±1.7074%,p=0.214）.The proportion of 39.2% in the AMI group patients at media-high risk was significantly higher than that in normal group（4%,p0.001）;there was significant positive correlation between DRs and SDNN,SDANN in AMI group（p0.05）.Conclusion DR4 and DR8 in AMI patients decreased significantly,and positively related to SDNN and SDANN,suggesting that DRs might be a quantitative assessment of vagus tension in AMI patients,and might become a new index for the application of predicting sudden death risk in patients with acute myocardial infarction in clinical.