急性心肌梗死患者溶栓前后心率震荡变化的意义

目的 探讨窦性心率震荡对急性心肌梗死(AMI)患者溶栓后冠脉再通血流的预测价值.方法 符合溶栓条件的AMI合并有室性早搏的患者60例,给予尿激酶溶栓治疗,于溶栓前、后连续动态心电图监测24 h,行窦性心率震荡(HRT)检测.根据临床再通条件分为再通组和非再通组,根据冠脉造影结果分为TIMI-Ⅲ级组和TIMI-Ⅱ级组,采用震荡初始(TO)与震荡斜率(TS)的特定公式做定量计算与分析,比较各组间溶栓前后TO与TS的变化.结果 31例AMI患者临床表现为有再通,再通率为51.7%,溶栓前2组TO和TS差异无显著性,(P＞0.05).溶栓后24 h两组TO、TS差异有显著性(P＜0.05).冠脉造影显示冠脉血流TIMI-Ⅲ级组和TIMI-Ⅱ级组比较,溶栓前2组TO、TS差异无显著性(P＞0.05),溶栓后TO、TS比较差异有显著性(P＜0.05).结论 HRT现象(TO、TS)可以预测冠脉再通情况,对冠脉血流亦有一定的预测价值.

The significance of heart rate turbulence change in patients with acute myocardial infarction after thrombolytic therapy

Objective To investigate the value of heart rateturbulence(HRT) for coronary flow in patients with acute myocardial infarction after thrombolytic therapy.Methods 60 patients with acute myocardial infarction complicated with ventricular premature pulse who could be treated by thrombolysis,the infarction related arteries were opened by urokinace. They were monitored by 24 h dynamic ECG,and HRT were measured.According to the clinical criterion of reperfusion,the patients were divided into two groups: reperfusion group or non-reperfusion group.According to the TIMI of coronary flow detected by CAG,the patients in reperfusion group were further divided into TIMI-3 grade group and TIMI-2 grade group.Turbulence onset(TO) and turbulence slope(TS) were analyzed and compared among groups by quantitative calculation and analysis with TO and TS special formula.Results The infarction related arteries were opened in 31 patients according to their clinical manifestations.The reopening rate was 51.7%,there is no significance difference in TO and TS between the two groups before thrombolitic therapy( P >0.05), but TO of reperfusion group decreased and TS increased,there was a significant difference between the two groups 24 h after thrombolitic therapy(P<0.05).There was no significant difference in TO and TS between TIMI-3 grade group and TIMI-2 grade group before thrombolitic therapy(P>0.05),however,there was a significant difference between the two groups after thrombolitic therapy(P<0.05).Conclusion HRT(TO and TS) monitoring can predict coronary artery opening state and the state of coronary artery flow.