急性心肌梗死溶栓后冠状动脉狭窄程度与心率变异性的相关性分析

目的:探讨急性心肌梗死(AMI)成功溶栓后不同程度冠状动脉狭窄与心率变异性(HRV)关系及临床意义。方法:42例溶栓成功AMI患者,溶栓后10 d行24 h动态心电图及冠状动脉造影术。心电分析系统检测HRV时域指标(SDNN、SDANN、RMSSD及PNN50);计算机辅助定量系统对冠状动脉病变处进行测量,按其狭窄程度分为轻度(残余狭窄70%)、中度(残余狭窄70%~90%)、重度狭窄(90%~99%)3组,分析溶栓后冠状动脉狭窄程度与HRV关系。结果:溶栓前轻度、中度及重度狭窄组间HRV各指标比较,差异无统计学意义(P0.05);溶栓后轻度狭窄组HRV各指标均显著高于溶栓前(P0.05)。而中度及重度狭窄组溶栓后HRV各指标与溶栓前比较虽有升高趋势,但差异无统计学意义(P0.05);溶栓后轻度狭窄组HRV各指标均明显高于重度狭窄组(P0.05)。结论:HRV对于预测溶栓成功后冠状动脉狭窄程度有一定的意义,可以作为评价自主神经功能受损程度较为理想的指标。

A correlative analysis between the severity of coronary artery stenosis and heart rate variability after thrombolytic therapy for acute myocardial infarction

Objective：To investigate the relationship between the extent of coronary stenosis and heart rate variability （HRV） after successful thrombolysis for acute myocardial infarction（AMI） and its clinical significance.Methods：Coronary angiography and 24 hours＇dynamic electrocardiogram were performed at the 10th day in 42 patients with AMI after successful thrombolysis.Using analysis system of ECG to detect parameters of HRV （SDNN,SDANN,RMSSD and PNNS0） and computer assisted quantitative system to measure coronary lesions after thrombolysis.Patients were divided into three groups according to the extent of coronary residual stenosis：mild stenosis group （〈 70%）,moderate stenosis group （70% ～ 90%）and severe stenosis group （90% ～ 99%）.The relationship between the extent of coronary stenosis and HRV after thrombolysis were analyzed.Results：There were no statistical difference in HRV index between three groups before thrombolysis （P 〉0.05） ; Compared with those of before thrombolysis,HRV index were significantly increased in mild stenosis group （P 〈0.05）,and there was increasing trend in moderate and severe stenosis group after thrombolysis,but the difference had no statistical significance （P 〉 0.05） ; HRV index in mild stenosis group were significantly higher than those in severe stenosis group after thrombolysis （P 〈 0.05）.Conclusions：HRV is of certain significance in predicting the extent of coronary stenosis after successful thrombolysis and will be a relative ideal index which can be used to evaluate the extent of autonomic nerve function damage.