急性冠脉综合征患者PCI术后的心率变异性及影响因素

Analysis of Heart Rate Variability and Its Influencing Factors in Patients with Acute Coronary Syndrome after PCI

目的探讨急性冠脉综合征患者行经皮冠状动脉支架植入术(PCI)后的心率变异性情况及其影响的临床因素。方法选取急性冠脉综合征行PCI手术的患者233例,根据其24 h动态心电记录中R-R间期总体标准差数值(SDNN)分为SDNN高组(SDNN≥101,共161例)和SDNN低组(SDNN<101,共72例),收集其一般临床资料、血液指标及24 h R-R间期总体标准差(SDNN),并进行统计分析。结果①SDNN高组的肌钙蛋白峰值、肌红蛋白峰值、肌酸激酶同工酶峰值、平均心率均显著低于SDNN低组(P<0.05),C反应蛋白、射血分数高于SDNN低组(P<0.05);②SDNN值与Gensini评分、超敏肌钙蛋白I峰值、肌红蛋白峰值、肌酸激酶同工酶峰值、白细胞计数、C反应蛋白、平均心率、B型钠尿肽合并糖尿病呈负相关(P<0.05);与血钙、射血分数呈正相关(P<0.05)。③线性回归结果显示,是合并糖尿病、B型钠尿肽升高、白细胞计数增多、平均心率增快是SDNN降低的重要危险因素(P<0.05)。结论急性冠脉综合征患者PCI术后,合并糖尿病、白细胞计数、心率、B型钠尿肽是心率变异性下降的独立危险因素,提示改善心率变异性应从控制血糖、改善炎症反应、改善心功能着手,从而改善患者预后。

Objective To investigate the heart rate variability in patients with acute coronary syndrome(ACS)after percutaneous coronary stent implantation(PCI)and its clinical factors.Methods Patients diagnosed with acute coronary syndrome and undergoing PCI surgery in our emergency department from January 2018 to December 2019 were selected.According to the total standard deviation of R-R interval(SDNN)in 24 h dynamic ECG records,the patients were divided into high SDNN group(SDNN≥101,161 cases)and low SDNN group(SDNN<101,72 cases).The general clinical data,blood parameter and 24-hour general standard deviation of R-R interval(SDNN)were collected,and SPSS statistics18.0 was used for statistical analysis.Results①The peak of troponin,peak of myoglobin,peak of creatine kinase-MB isoenzyme,C-reactive protein,average heart rate and ejection fraction in high SDNN group were significantly lower than those in low SDNN group,and the differences were statistically significant(P<0.05).②SDNN value and Gensini score(r=-0.184,P=0.005),peak of hypersensitive troponin I(r=-0.236,P=0.000),peak of myoglobin(r=-0.195,P=0.003),peak of creatine kinase-MB isoenzyme(r=-0.175,P=0.008),white blood cell count,C-reactive protein,average heart rate and B-type natriuretic peptide and combined with diabeles(P<0.05),were negatively correlated and positively correlated with serum calcium and ejection fraction(r=0.361,P=0.000).③The results of linear regression showed that diabetes mellitus(β=-12.243),increased B-type natriuretic peptide(β=-0.006),increased white blood cell count(β=-2.537),and increased mean heart rate(β=-1.257)were the important risk factors for decreased SDNN(P<0.05).Conclusion In patients with acute coronary syndrome after PCI,diabetes mellitus,higher white blood cell count,higher heart rate,and higher B-type natriuretic peptide are independent risk factors for decreased heart rate variability,suggesting that heart rate variability should be improved by controlling blood glucose,improving inflammatory response,and improving cardiac function,so as to improve the prognosis of patients.