β受体阻滞药干预急性心肌梗死心率变异性改变的多因素研究

目的 :观察急性心肌梗死 ( AMI)病人心率变异性 ( HRV)改变及小剂量倍他乐克对 AMI病人 HRV改变的干预。方法 :分析 67例 AMI病人 2 4h HRV时域指标 ;年龄、性别与其匹配的健康对照组 40例。AMI病人分为倍他乐克组 ( n=42 )及对照组 ( n=2 5 )。测定两组病人用药前及用药后 3 mo的 2 4h HRV。对倍他乐克组治疗前后 2 4h HRV时域指标进行多方面分析。结果 :a.AMI组 HRV各项时域指标较正常对照组显著降低 ,P <0 .0 0 1 ;b.AMI组中前壁梗死各项 HRV时域指标虽较下壁低下 ,但未达统计学意义 ,P >0 .0 5 ;c.AMI组住院期间发生室性心律失常者 HRV时域指标较无室性心律失常者显著降低 ,P <0 .0 5 ;d.应用倍他乐克 2 5 mg/d3 mo后 HRV各项时域指标较对照组明显恢复 ,P <0 .0 5 ,病人心律失常发生率及病死率较对照组明显降低 ,P<0 .0 5 ;e.小剂量倍他乐克对不同部位、不同年龄、不同性别心肌梗死病人 HRV各项时域指标的影响无显著性差异 ,P >0 .0 5。结论 :AMI后存在 HRV降低 ,前壁梗死较下壁梗死 HRV略低但无统计学意义 ,HRV的降低与室性心律失常正相关 ,应用小剂量倍他乐克可显著改善降低的 HRV,减少心律失常的发生率 ,降低病死率 ,且对不同部位、不同年龄、不同性别的 AMI病人 HRV改善无差异 ,具有普遍适用性

STUDY OF EFFECTS OF β-RECEPTOR BLOCKERS ON HEART RATE VARIABILITY IN ACUTE MYOCARDIAL INFARCTION

Objective: To observe the change of heart rate variability(HRV) in acute myocardial infarction(AMI) and effects of small dose betaloc on HRV in AMI. Methods: HRV in 67 patients with AMI and control group (n=40) of healthy subjects with matched age and sex were analysed. The patients with AMI were randomly divided into 2 groups: the betaloc group (n=42) and the control group (n=25). 24-hour HRV were examined before medication and 3 months after medication. Time domain values of 24-hour HRV in betaloc group before medication and after medication were analysed. Results: (1)Time domain values of HRV after AMI were significantly lower compared with the controls, P<0.001; (2)Comparing HRV between anterior and inferior wall infarction, we did not find any statistical difference; (3)The time domain values of HRV were significantly lower in patients with ventricular arrhythmia(VA) events than those without VA events; (4)Use of small dose betaloc 25mg/d after 3 months, time domain values of HRV were improved significantly and the rates of VA and death were decreased compared with control group; (5)The effects of small dose betaloc in different infarction site, different age and different sex have no any statistical difference. Conclusion: There were HRV decreased in AMI. HRV in anterior wall infarction is lower than that in inferior wall infarction, but have no statistical difference. HRV is more lower, when VA events is more higher. Use small dose betaloc can improve HRV significantly, decrease arrhythmia and death rate, and the improvement of HRV in different infarction site, age and sex have no statistical difference. Small dose betaloc can be used widely.