动态心电图在急性心肌梗死后LVEF≥35%患者自主神经功能评估中的应用研究

Application study of dynamic electrocardiogram in assessing autonomic nervous function in patients with LVEF ≥35% after acute myocardial infarction

目的分析动态心电图在急性心肌梗死后左室射血分数(LVEF)≥35%患者自主神经功能评估中的效果。方法将74例急性心肌梗死后LVEF≥35%患者纳入观察组,另将体检的63例健康人群纳入对照组。两组均进行动态心电图检测,对比两组正常相邻窦性R-R间期差值均方根(rMSSD)、正常窦性R-R间期总体标准差(SDNN)、R-R间期的平均值标准差(SDANN)、震荡斜率(TS);另绘制受试者工作特征曲线(ROC曲线),分析动态心电图各项参数单独或联合评估急性心肌梗死后LVEF≥35%患者自主神经功能的效果。结果观察组rMSSD为(8.03±1.49)ms、SDNN为(89.76±5.32)ms、SDANN为(73.29±4.26)ms、TS为(2.18±0.43)ms/R-R,低于对照组的(23.67±3.71)ms、(126.95±8.58)ms、(112.84±6.49)ms、(3.59±0.67)ms/R-R,差异有统计学意义(P<0.05)。ROC曲线结果显示,rMSSD、SDNN、SDANN、TS联合检测的曲线下面积(AUC)为0.920[95%CI=(0.865,0.976)],高于各项参数单独检测的0.839[95%CI=(0.769,0.908)]、0.784[95%CI=(0.700,0.868)]、0.754[95%CI=(0.668,0.841)]、0.858[95%CI=(0.791,0.925)]。结论动态心电图可有效评估急性心肌梗死后LVEF≥35%患者的自主神经功能,为临床提供可靠依据,值得大力推行。

Objective To analyze the effect of dynamic electrocardiogram in assessing autonomic nervous function in patients with left ventricular ejection fraction(LVEF)≥35%after acute myocardial infarction.Methods 74 patients with LVEF≥35%after acute myocardial infarction were included in the observation group;In addition,63 healthy individuals who underwent physical examinations were included in the control group.Dynamic electrocardiogram was performed in the two groups to compare the square root of sinus R-R interval(rMSSD),standard deviation of sinus R-R interval(SDNN),standard deviation of mean sinus R-R interval every 5 min(SDANN),and oscillation slope(TS)between the two groups;Additionally,a receiver operating characteristic(ROC curve)was drawn to analyze the effect of various parameters alone or in combination to access autonomic nervous function of patients with LVEF≥35%after acute myocardial infarction.Results The rMSSD of the observation group was(8.03±1.49)ms,SDNN was(89.76±5.32)ms,SDANN was(73.29±4.26)ms,and TS was(2.18±0.43)ms/R-R,which were lower than the control group's(23.67±3.71)ms,(126.95±8.58)ms,(112.84±6.49)ms,and(3.59±0.67)ms/R-R,with a statistically significant difference(P<0.05).The ROC curve results showed that the combined detection of rMSSD,SDNN,SDANN,and TS had an area under the curve(AUC)of 0.920[95%CI=(0.865,0.976)],which was higher than the individual detection of 0.839[95%CI=(0.769,0.908)],0.784[95%CI=(0.700,0.868)],0.754[95%CI=(0.668,0.841)],and 0.858[95%CI=(0.791,0.925)].Conclusion Dynamic electrocardiogram can effectively evaluate the autonomic nervous function of patients with LVEF≥35%after acute myocardial infarction,thus providing a reliable basis for clinical practice and can be vigorously promoted.