小剂量洋地黄对急性心肌梗死PCI术后合并心力衰竭患者心率变异性的影响

Effect of Low Dose Digitalis on Heart Rate Variability in the Patients of Reperfused Acute Myocardial Infarction with Acute Heart Failure

目的:探讨早期应用小剂量洋地黄类药物对急性心肌梗死(Acute myocardial infarction,AMI)行经皮冠状动脉介入治疗(Percutaneous coronary intervention,PCI)术后合并心力衰竭患者心率变异性(Heart rate variability,HRV)的影响。方法:入选32例在发病24小时内接受PCI治疗且合并心力衰竭的AMI患者,再灌注后随机分为洋地黄组(西地兰0.2 mg,n=17)和对照组(生理盐水20 m L,n=15)。在用药前、用药后30分钟、用药后3小时、用药后6小时、用药后12小时、用药后24小时进行5分钟HRV分析。结果:1洋地黄组的心率在用药6小时后显著小于对照组(P<0.05);2洋地黄组SDNN在用药后3小时-6小时显著大于对照组(P<0.05),两组RMSSD比较无显著统计学差别(P>0.05);3洋地黄组LFnorm在用药后3小时-6小时显著大于对照组(P<0.05);用药3小时后,洋地黄组HFnorm显著大于对照组(P<0.05),LF/HF显著小于对照组(P<0.05)。结论:小剂量洋地黄可以显著降低AMI PCI术后合并心力衰竭患者的心率、逆转迷走神经与交感神经活性的失衡状态,改善HRV。

Objective： To investigate the effect of digitalis on heart rate variability（HRV） in patients with acute heart failure following acute myocardial infarction（AMI） who underwent percutaneous coronary intervention（PCI）. Methods： A total of 32 consecutive patients with acute heart failure following AMI within 24 hours who underwent PCI were enrolled in this study. The patients were randomly divided into two groups after reperfusion therapy： digitalis group（Cedilanid 0.2 mg, n=17） and control group（saline 20 m L, n=15）. Electrocardiogram signals were recorded before medication, 30 minutes, 3 hours, 6 hours, 12 hours, and 24 hours after medication, and then 5 minutes of Time-domain and Frequency-domain of HRV parameters were analyzed. Results： The heart rate of the digitalis group was significantly lower than that of control group from 6h to 24 h after medication（P0.05）. SDNN of digitalis group was significantly higher than that of control group between 3 hours and 6 hours after medication（P0.05）, and there was no statistically difference of RMSSD between the two groups. LFnorm of digitalis group was significantly higher than that of control group from 3 hours to 6 hours after medication（P0.05）. HFnorm of digitalis group was remarkable higher than that of control group from 3 hours to 24 hours after medication（P0.05）, and the ratio of LF/HF in digitalis group was significantly lower than that of control group（P0.05）.Conclusion： Low dose digitalis reduced heart rate and improved sympatho-vagal imbalance and HRV in the patients with AMI with acute heart failure who underwent PCI in the early stage.