冠心病患者PTCA术前后不同冠脉病变支数心率变异性的对比分析

目的　观察不同冠脉病变支数患者心率变异性 (HRV)的变化有无差异及经皮腔内冠脉成形术 (PTCA)对HRV的影响。方法　应用动态心电图中心率变异性的时域和频域分析技术 ,对不同冠脉病变支数患者在PTCA术前、术后 1周及 6个月的自主神经活性进行对比分析。其中单支病变 2 3例 ,双支病变 2 7例 ,三支病变 18例。结果　 (1)PTCA术后 1周HRV较术前有所改善 ,但差异无统计学意义 (P >0 0 5 ) ,术后 6个月HRV明显增高 ,差异有统计学意义 (P <0 0 5 ) ;(2 )PTCA术前、术后冠脉单支、双支、三支病变各组间HRV差异均无统计学意义。结论　冠心病患者HRV的改变可能与神经体液因素对窦房结功能的调控失衡有关 ,而与冠脉病变支数无关。PTCA术后远期HRV显著改善 ,其机制可能与PTCA术改善患者心肌缺血有关。

COMPARATIVE ANALYSIS OF VARIABILITY OF HEART RATE IN RELATION TO NUMBER OF PATHOLOGICAL BRANCHES OF CORONARY ARTERY BEFORE AND AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY(PTCA)

objective To observe whether there was any change in variability of heart rate (HRV) among patients in relation to different number of pathological branches of coronary artery before and after PTCA. Methods With the time and frequency domain analytical technology, we made a comparative study of the autonomic nervous activities of the patients (in our hospital) with different number of pathological coronary branches in 68 patients with coronary disease before PTCA and 1 week and 6 months after PTCA. Among them, 23 cases had monobranch disease, 27 cases bibranch disease and 18 cases tribranch disease. Results (1)One week after PTCA, the HRV was improved to some extent, but with no statistical significance(P>0.05). The RHV was obviously improved 6 months after PTCA(P<0.05).(2)There was no obvious difference in HRV among the patients in three groups before and after PTCA. Conclusion The changes in HRV in patients with coronary heart disease may be related to impairment of sinus nodal function due to neuro-humoral factors. They are not related with the number of branches of pathological coronary artery. The HRV in patients can be improved obviously after PTCA, and it may be due to improvement in myocardial circulation after PTCA.