静息心率与冠心病的临床观察及随访研究

目的探讨静息心率（RHR）在老年冠心病（CHD）患者中的变化及临床意义。方法选择103例老年CHD患者（CHD组）进行RHR测定,以70例同期体检无异常发现者作为正常对照组。CHD组分为急性心肌梗死、不稳定型心绞痛及稳定型心绞痛组,观察RHR与心肌缺血、心律失常之间的关系,并使用β-受体阻滞剂干预。结果 CHD组RHR（80.1±7.8）次/min]显著快于正常对照组（70.6±7.2）次/min]（P〈0.05）;急性心肌梗死组RHR（87.1±6.9）次/min]快于不稳定型心绞痛组（81.2±9.2）次/min]及稳定型心绞痛组（72.9±7.8）次/min]（P〈0.05）;不稳定型心绞痛组RHR快于稳定型心绞痛组（P〈0.05）。CHD组中RHR≥80次/min的患者心肌缺血总负荷（TIB）与RHR 74~79次/min及RHR〈74次/min的患者比较差异有统计学意义（P〈0.05）;CHD组中RHR≥80次/min时心律失常的发生率最高,不同RHR水平心律失常的发生率比较差异有统计学意义（P〈0.05）。使用β-受体阻滞剂干预后,RHR控制在50~60次/min时,心肌缺血及心律失常的发生率最低。结论 RHR与冠心病的发展及预后有密切关系;通过β-受体阻滞剂干预RHR可控制症状,改善心血管疾病的预后。

Clinical observation and follow-up study of resting heart rate and coronary heart disease.

Objective To investigate the changes and significance of resting heart rate （RHR） in elderly patients with coronmy heart disease （CHD）. Methods One hundred and three elderly pati~ts with CHD （CHD group） wer~ examined RHR, and 70 healthy people who had medical examination with no abnormal findings in the same period were regarded as the control group. CHD group was divided into acute myocardial infarction subgroup, unstable angina subgroup and stable angina subgroup to observe the correlation among RHR, ischemia and an＇hythmia, who intervened byfl-blockers. Results The RHR was significantly increased in CHD g~oup than the conl~l group （80.1~7.8） times/min vs （70.6~7.2） times/min, P〈0.05）. The RHR was increased in acute myocardial infarction subgroup than unstable angina subgroup and stable angina sub- group （87.1~6.9） times/min vs （81.2~9.2） times/min and （72.9~7.8） times/min, P〈0.05）. The RHR was increased in un- stable angina subgroup with stable angina subgroup （P〈0.05）. The TIB among CHD patients with RI-IR~〉80 times/rain, 74 times/min~〈RHR〈79 times/min and RHR〈74 times/min showed statistically significant difference （P〈0.05）. Pa- tients in CHD group with RHR~〉80 times/min had the highest incidence of arrhythmia, and incidence of arrhythmia showed statistically significant difference between the three groups with different levels of RHR （P〈0.05）. After 3-blockers interfering to control RHR in 50---60 times/min, the incidence of myocardial ischemia and arrhythmia was lowest. Conclusion RHR is closely related to the development and prognosis of CHD. The prognosis of cardiovascu- lar diseases could be improved and symptoms could be controlled with intervening RHR by fl-blockers.