血压及心率变异性对急性心肌梗死后患者预后价值的研究

Research on prognostic value of blood pressure variability and heart rate variability in the patients post-infarction

目的 研究急性心肌梗死后患者心率变异性 (HRV)、血压变异性 (BPV)的改变 ,评价 HRV及BPV对患者远期恶性心律失常及心脏性猝死的预测价值 ,探讨 BPV预测价值的临床意义。方法 6 8例急性心肌梗死后行 2 4 h动态心电血压监测检查的患者 ,根据动态心电图检查结果分为非心律失常组及心律失常组 ,记录非心律失常组 HRV、BPV各值及心律失常组的 BPV各值 ,并与 19名正常对照组的 HRV、BPV值相比较。全部患者平均随访 12个月。比较两组发生恶性心脏事件及猝死者与未发生者 HRV、BPV改变情况 ,分别评价心律失常组 BPV,非心律失常组 BPV、H RV各自及两者结合的预测敏感度、特异度。结果 与正常对照组比较 ,急性心肌梗死后患者 HRV各值减小 ,BPV各值增大。在随访期内非心律失常组发生心脏事件 4例 ,心律失常组发生 3例。以 SDNN<5 0 ms及 DSD夜 >8m m Hg为指标 ,非心律失常组 HRV预测的敏感度为 75 % ,特异度为 87% ,BPV预测的敏感度为 5 0 % ,特异度 77% ,两者结合预测的敏感度、特异度分别为 5 0 % ,97%。心律失常组以 DSD夜>8mm Hg为指标预测的敏感度、特异度分别为 6 7% ,74 %。结论 与 HRV相比 BPV也是一个较好的心肌梗死预后指标 ,BPV与 H RV两者结合可以显著提高预测价值。 BPV对心肌梗死后合并心律失?

Objective To evaluate the relation between the changes of blood pressure variability (BPV) and heart rate variability (HRV) with subsequent occurrence of lethal arrhythmia and sudden cardiac death in the patients after acute myocardial infarction and survived 7～14 days.Methods A 24-hour ambulatory cardiac and blood pressure monitoring was performed on 68 patients 7～14 days after AMI and 19 normal subjects.According to the cardiac recording,the post-infarction patients were divided into arrhythmia groups and non-arrhythmia group.The HRV and BPV of non-arrhythmia group and the BPV of arrhythmia group were contrasted with those of normal subjects.After a mean 12 months follow-up,calculating the prognostic sensitivity and specificity for lethalarrhythmia and sudden cardiac death of SDNN<50 ms,DSD n>8 mm Hg in the non-arrhythmia group respectively and together,and that of DSD n>8 mm Hg in the arrhythmia group.Results In contrast with normal subjects there were reduced HRV and increased BPV in the patients post-infarction.During a mean follow-up of 12 months,there were 3 lethal arrhythmia in the arrhythmia group,and 4 in the non-arrhythmia group.SDNN<50 ms,DSD n>8 mm Hg predictive sensitivity was respectively 75%,50%,specificity was 87%,77% and combined sensitivity was 50%,speciality was 97% in the non-arrhythmia group.DSD n>8 mm Hg predictive sensibility and specificity were respectively 67%,74% in arrhythmia group.Conclusion BPV is also a good predictor for the sudden cardiac death and lethal arrhythmia in the patients post-infarction in comparison with HRV.The combined BPV and HRV may increase the predictive value for AMI patient prognosis.BPV is superior to HRV for the patients with arrhythmia after infarction to predict sudden cardiac death.