急性心肌梗死后不同病程患者的连续心率减速力和心脏猝死差异的比较及相关性分析

Difference and correlation of heart rate deceleration runs and sudden cardiac death in patients with acute myocardial infarction in different courses

目的探讨急性心肌梗死(AMI)后不同病程患者连续心率减速力(DRs)和心脏猝死差异,并分析其相关性。方法选取2018年1月至2018年12月于河北北方学院附属第一医院收治的200例AMI后患者作为研究对象,根据梗死后时间不同分为四组:A组(<1个月)、B组(1~3个月)、C组(3~6个月)和D组(>6个月);所有患者均进行了24 h动态心电图和M型超声心动图仪检查。对比各组心率减速力(DC)指标:DC值、DRs值;心率变异性指标:震荡初始(TO)、震荡斜率(TS)、正常窦性RR间期的标准差(SDNN)值;心功能指标:左心室收缩压(LVSP)和左室射血分数(LVEF)值,并进行相关性分析。结果DC、DR2、DR4、TS和SDNN在A、B、C和D四组中依次升高,且四组比较差异有统计学意义(P<0.05),但在DR8和TO比较上差异无统计学意义(P>0.05)。A组、B组、C组和D组各组低风险层、中风险层和高风险层占比比较,差异有统计学意义(P<0.05)。A组、B组、C组和D组LVSP和LVEF依次升高,且四组比较差异有统计学意义(P<0.05)。经Pearson相关分析得知,DC与LVSP、LVEF呈明显正相关(r=0.385、0.421,P均<0.05);TS与LVSP、LVEF呈明显正相关(r=0.346、0.411,P均<0.05);SDNN与LVSP、LVEF呈明显正相关(r=0.329、0.485,P均<0.05);但TO与LVSP、LVEF相关性不大(r=0.142、0.172,P均>0.05)。结论AMI后不同病程患者心率减速力、心率变异性、心功能指标及危险分层差异明显,其心率减速力、心率变异性与心功能指标明显相关。

Objective To investigate the difference in heart rate deceleration runs(DRs)and sudden cardiac death(SCD)in patients with acute myocardial infarction(AMI)in different disease courses,and analyze correlation among DRs,SCD and heart function.Methods AMI patients(n=200)were chosen from the First Affiliated Hospital of Hebei North University from Jan.2018 to Dec.2018,and divided,according to different disease courses of AMI,into group A(<1 month),group B(1 month to 3 months),group C(3 months to 6 months)and group D(>6 months).The examinations of 24-h dynamic electrocardiogram and M-mode echocardiography were performed in all groups.The indexes of deceleration capacity of rate(DC)including values of DC value and DRs,indexes of heart rate variability(HRV)including values of heart rate turbulence onset(TO),heart rate turbulence slop(TS)and standard deviation of normal sinus RR interval(SDNN),and indexes of heart function including left ventricular systolic pressure(LVSP)and left ventricular ejection fraction(LVEF)were compared in all groups and a correlation analysis was conducted.Results DC,DR2,DR4,TS and SDNN increased successively in groups A,B,C and D,and difference had statistical significance(P<0.05),but there was no significant difference in DR8 and TO(P>0.05)among 4 groups.The difference in proportion of low-risk,medium risk and high-risk in groups A,B,C and D had statistically significance(P<0.05).LVSP and LVEF increased in turn in group A,group B,group C and group D,and the difference had statistically significance among 4 groups(P<0.05).The results of Pearson correlation analysis showed that DC was positively correlated to LVSP and LVEF(r=0.385,r=0.421,all P<0.05),TS was positively correlated to LVSP and LVEF(r=0.346,r=0.411,all P<0.05),and SDNN was positively correlated to LVSP and LVEF(r=0.329,r=0.485,all P<0.05),but TO was not significantly correlated to LVSP and LVEF(r=0.142,r=0.172,all P<0.05).Conclusion DC,HRV,heart function indexes and risk stratification have significant difference in AMI patients in different disease courses,and DC and HRV are closely correlated to heart function indexes.