急性心肌梗塞患者尿儿茶酚胺变化及其与临床和心率变异性的关系

使用高效液相色谱分离技术连续测定２５例急性心肌梗塞（ＡＭＩ）患者发病初４周２４小时尿儿茶酚胺含量及变化。ＡＭＩ患者尿去甲肾上腺素（ＮＥ）和多巴胺含量明显升高，随病情恢复逐步下降，以发病后第一周下降幅度最大。ＮＥ含量与心率变异三项参数极低频成分、总成分和连续５分钟正常心率间期标准差均值相关（ｒ＝－０．７１２３、－０．６１５、－０．５２８，Ｐ＜０．０５）；与心肌酶相关（ｒ＝０．６３５，Ｐ＜０．０５）；与室早总数相关（ｒ＝０．５１５，Ｐ＜０．０５）。说明心率变异反映交感活性，尿ＮＥ水平可反映心肌坏死范围，儿茶酚胺增高有致心律失常作用。

Changes of catecholamine in patients with acute myocardial infarction and its association with heart rate variability

In order to analyze the changes and the clinical significance of catecholamine in patients with acute myocardial infarction (AMI), 24 hour urinary catecholamine was measured with HPLC in 25 consecutive patients within 4 weeks after the onset of AMI. The results showed that norepinephrine and dopamine elevated significantly after AMI attack, and then decreased gradually with more rapidly decreasing in the first week (41% and 42% respectively). Twenty four hour urinary norepinephrine negatively correlated with three parameters of heart rate variability ( P <0.05),and positively correlated with peak creatine kinase ( r =0.6348, P <0.05). The level of norepinephrine was also found to be associated with the number of 24 hour ventricular ectopics ( r =0.5153, P <0.05). It is concluded that heart rate variability can reflect sympathetic activity. Higher catecholamine level in AMI may reflect larger size of myocardial necrosis and may have proarrhythmic effects.