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急性心肌梗死患者溶栓对心率变异性的影响(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
1998年第3期
页码:
154-156
栏目:
论著
出版日期:
1998-05-01

文章信息/Info

Title:
Effects of thrombolytic therapy on heart rate variability in patients with acute myocardial infa ction
作者:
黄新平 田 丹 邹川南 金志泽　陈 芳 李 玉
云南省红十字会医院心内科　昆明 650021
Author(s):
Huang Xinping ;  Tian Dan;  Zhou Chuannan;  Jin Zhize;  Chen Fang ; Li Yu
Department of Cardiology, the Red Cross Hospital of Yunnan Province, Kunming 650021
关键词:
心肌梗死;  急性　溶栓疗法　心率变异性　植物神经系统
Keywords:
myocardial infarction;  acute　　thrombolytic therapy　　heart rate variabitity sympathovagal system
分类号:
-
DOI:
-
文献标识码:
-
摘要:
选取急性心肌梗死(AMI) 患者31例, 并设正常对照组。采用时域法和频域法研究AMI溶栓治疗后心率变异性(HRV) 的改变。其结果显示: 在AMI再通组,其SDNN为108.14±28.40ms, 高于未通组的62.67±26.12ms(P < 0.01) 但低于对照组的128.47±35.61 ms (P < 0.05) ; 其高频面积为284.82±276.45, 大于未通组的(135.68±117.82 bpm2/Hz, P < 0.05) 但小于对照组的(694.35±540.11 bpm2/Hz, P < 0.01) ; 其低频面积/高频面积为0.93±0.71, 小于未通组的1.74±1.07 (P < 0.05) , 但大于对照组的0.53±0.61 (P < 0.01) ; 其低频面积虽大于未通组和小于对照组, 但无统计学意义。本结果表明,AMI后HRV变小, 其迷走神经活性下降, 交感神经作用相对增强; 溶栓再通后的HRV 增大, 其迷走神经兴奋性增高, 交感神经作用减弱。故成功的溶栓治疗对改善AMI后自主神经系统功能失衡和减少由此引起的致命性心律失常等事件的发生有积极意义。
Abstract:
Both time domain and frequency domain were used to investigate changes in heart rate variabitity (HRV) after thrombolytic therapy in patients with acute myocardial infarction(AMI).In the reperfused group (n=21),its SDNN(108.14±28.40 ms) was higher than in the non-reperfused group (n=10,62.67±26.12 ms, P < 0.01) and lower than in the control subjects(n=35,128.47 ± 35.61 ms, P < 0.05) ; its area of high-frequency( 284.82 ± 276.45 bpm2/Hz) was greater than in the non-reperfused group (135.68±117.82 bpm2/Hz, P < 0.05) and smaller than in the control group (694.35±540.11bpm2/Hz, P < 0.01) ; and its area ratio of low-to high-frequency(0.93±0.71) was smaller than in the non-reperfused group (1.74±1.07, P < 0.05) and greater than in the control group (0.53 ± 0.61, P < 0.01).The area of low-frequency in the reperfused group was greater and smaller than in the non-reperfused and the control group respectively, however, it had no great significance.Our resuits demonstrated that low HRV with diminished vagal function and predominance of sympathetic activity in patients with AMI became greater with an increased vagal tone and decreased sympathetic function in the reperfused group after thrombolysis.It is, therefore, obvious that the thrombolytic therapy which causes recanalization of infarct-related coronary arteries plays an active role in improvement of the sympathovagal imbalance after AMI and reduction of lethal arrhythmias caused by such imbalance.

参考文献/References

［1］Schwartz PJ , La Rovere MT ,Vanoli E.Autonomic nervous system and sudden cardiac death. Circu lation,1992; 85 (Suppl Ⅰ) : 1277.

［2］Stein PK,Bosner MS, Keiger RE, et al.Heart rate variability: A measure of cardiac autonomic tone.Am Heart J , 1994; 127: 1376.

［3］ Lombardi F, Sanerone G, Pernmner S, et al.Heart rate variability as an index of sympathovagal interaction after acute myocardial infarction.Am J Cardiol, 1987; 60:1239.

［4］中华心血管病杂志编委会.急性心肌梗塞溶栓疗法参考方案.中华心血管病杂志, 1991; 19: 137.

［5］Pilis A , Flather M , Ormerod O , et al.Heart rate variability in acute myocardial infarction and its association with infarction site and clinical course.Am J Cardiol,1991; 67: 1137.

［6］Kleiger RE,Miller FP,Bigger JT , et al.Decreased heart rate variability and its association with increased mortality after acute myocardial infarction.Am J Cardiol,1987; 59: 256.

备注/Memo

备注/Memo:
(收稿1997-07-22)
更新日期/Last Update: 1998-05-01