急性心肌梗死早期溶栓治疗效果与心率变异性的关系

The effects of early thrombolytic th erapy on heart rate variability in patients with acute myocardial infarc tion

目的:探讨急性心肌梗死(acutemyocardialinfarction,AMI)早期溶栓治疗对心率变异性(heartratevariability,HRV)的影响。方法:264例首次Q波AMI患者按有无接受早期静脉溶栓治疗分为溶栓组119例、非溶栓组145例;溶栓组根据溶栓治疗成功与否又分为溶栓成功组68例和溶栓失败组51例。264例均在起病14日后行24小时动态心电图检查和HRV分析。结果:①溶栓成功组HRV时域分析指标24小时正常R-R间期的标准差、24小时内每5分钟节段平均正常R-R间期的标准差、24小时内每5分钟节段正常R-R间期标准差的平均值、连续正常R-R间期差值均方的平方根、差值超过50ms的R-R间期在一定时间内的百分比及频域分析指标总能谱、低能谱、高能谱均大于溶栓失败组和非溶栓组(P<0.01),溶栓成功组频域分析指标低能谱/高能谱比值小于溶栓失败组和非溶栓组(P<0.01);②溶栓失败组与非溶栓组所有HRV分析指标均无统计学差异(P>0.05)。结论:AMI早期溶栓治疗成功能改善病人的HRV,提示AMI早期梗死相关冠状动脉再通能提高心肌电稳定性。

Objective:To assess the effects of early thromb olytic therapy on heart rate variabi lity(HRV)in patients with a-cute myocardial infarction(AMI ).Methods :Two hundreds and sixty-four patient s with a first Q wave AMI who met the criteria of HRV measurement were divided into th ree groups:the successful thrombolytic therap y group(n=68),the non-successful throm-bolytic therapy group(n=51)and the non-thrombolytic therapy group(n=145).All subjects received 24-hour ambu latory electro-cardiogram(Holter)and HRV analysis within two weeks after onset of AMI.Results:The standard deviation of all 24-hou r NN in-tervals(SDNN),the standard deviation of the averages of NN intervals in all 5-minute segments of the entire 24-hour recordin g(SDANN),the mean of the standard deviations o f all NN intervals for all 5-minute se gments of the entire 24-hour recordi ng(SD),the square root of the mean of the sum o f the squares of differences between adjacent NN intervals(rMSSD),the number of pairs of adjacent NN intervals differing by more than 50ms count divided by the total number of all NN intervals(PNN 50 ),total power fre-quency(TF),low power frequency(LF)and high power frequency(HF)in the successful thrombolytic therapy group were signifi-cantly higher than those in the non-s uccessful thrombolytic therapy gro up and in the non-thrombolytic thera py group(P<0.01).The ratio of LF /HF in the successful thro mbolytic therapy group was signific antly smaller than those in non-succ essful thrombolytic therapy group and the non-thrombolytic grou p(P<0.01);②There were no statistically significant differences between the non-su ccessful thrombolytic therapy group and the n on-thrombolytic group(P>0.05).Conclusion:Successful early thrombolytic therapy can im-prove HRV in patients with AMI ,suggesting that early revasculariz ation of infarct-related artery in AMI improves myocardial electrical stability.