吉林大学学报(医学版) ›› 2018, Vol. 44 ›› Issue (04): 780-785.doi: 10.13481/j.1671-587x.20180416

• 临床研究 • 上一篇    下一篇

急性心肌梗死患者PCI术后心率变异性对主要不良心脏事件的评估价值

朱涛1, 张国明2, 严飞1, 刘正1, 霍强1   

  1. 1. 新疆医科大学第一附属医院心外一科, 新疆 乌鲁木齐 830054;
    2. 新疆医科大学第一附属医院小儿外科, 新疆 乌鲁木齐 830054
  • 收稿日期:2017-06-19 出版日期:2018-07-28 发布日期:2018-07-27
  • 通讯作者: 霍强,主任医师,硕士研究生导师(Tel:0991-4366925,E-mail:huoqiangxinjiang@126.com) E-mail:huoqiangxinjiang@126.com
  • 作者简介:朱涛(1979-),男,新疆维吾尔自治区乌鲁木齐市人,主治医师,医学硕士,主要从事心血管系统疾病临床诊治方面的研究。
  • 基金资助:
    新疆维吾尔自治区科技厅自然科学基金资助课题(2016D01C336)

Values of evaluation of heart rate variability in major adverse cardiac events in patients with acute myocardial infarction after PCI

ZHANG Tao1, ZHANG Guoming2, YAN Fei1, LIU Zheng1, HUO Qiang1   

  1. 1. Department of Cardiovascular Surgery, First Affiliated Hospital, Xinjiang Medical University, Xinjiang 830054, China;
    2. Department of Pediatric Surgery, First Affiliated Hospital, Xinjiang Medical University, Xinjiang 830054, China
  • Received:2017-06-19 Online:2018-07-28 Published:2018-07-27

摘要: 目的:探讨急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)术后心率变异性(HRV)对评估短期主要不良心脏事件(MACE)的临床价值。方法:选择接受PCI的AMI患者160例,根据术后3个月内是否发生MACE分为对照组126例(术后3个月内未发生MACE)和研究组34例(术后3个月内发生MACE)。比较2组患者全部正常窦性心搏间期标准差(SDNN)、平均正常窦性心搏间期标准差(SDANN)、每5min正常窦性心搏间期标准差的平均值(SDNNIDX)、相差50ms以上相邻窦性心搏间期数占窦性心搏间期总数的百分比(PNN50)、全程相邻正常窦性心搏间期差的均方根值(rMSSD)、低频(LF)和高频(HF)等HRV主要指标的差异。计算每个患者的冠脉Gensini评分,分析冠脉Gensini评分与HRV主要指标的相关性。随访3个月,应用多元Logistic回归分析HRV主要指标与MACE发生的危险程度。结果:研究组患者的SDNN、SDANN、SDNNIDX、PNN50、RMSSD和HF水平低于对照组(P<0.05),而LF水平高于对照组(P<0.05)。患者冠脉Gensini评分与SDNN、SDANN和SDNNIDX均呈负相关关系(r=-0.827,r=-0.789,r=-0.698,P<0.05),但冠脉Gensini评分与rMSSD、pNN50、LF和HF无相关关系(P>0.05)。多元Logistic回归分析,SDNN、SDANN和SDNNIDX为MACE发生的保护因素(P<0.05)。结论:AMI患者PCI术后反映交感神经系统功能的HRV指标能反映冠脉病变程度并对术后短期预后结局判断有预测价值。

关键词: 急性心肌梗死, 心率变异性, 主要不良心脏事件, 预后, 经皮冠状动脉介入治疗术

Abstract: Objective:To evaluate the clinical value of heart rate variability (HRV) in evaluation on the short-term major adverse cardiac events (MACE) in the patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). Methods:A total of 160 AMI patients received PCI were collected and divided into control group (126 cases,there was no MACE during 3 months after PCI) and research group (34 cases,there was MACE during 3 months after PCI) according to the occurrence of MACE after operation. The main HRV indexes including SDNN,SDANN,SDNNIDX,PNN50,RMSSD,LF and HF of the patients in two groups were compared. The Gensini scores of coronary artery of each patient were calculated. The relationships of the main HRV indexes and the Gensini scores of coronary artery were analyzed. After 3 months of follow-up,the risk factors of the main HRV indexes to the occurrence of MACE were confirmed by multivariate Logistic analysis. Results: The main HRV indexes including SDNN,SDANN,SDNNIDX,PNN50,RMSSD and HF of the patients in research group were lower than those in control group (all P<0.05),but LF in research group was higher than that in control group (P<0.05).The negative relationships between SDNN,SDANN,SDNNIDX and the Gensini scores were confirmed (r=-0.827,r=-0.789,r=-0.698, P<0.05),but rMSSD,pNN50,LF and HF had no relationship with the Gensini scores (P>0.05). The multivariant Logistic analysis showed that SDNN,SDANN,SDNNIDX were the independent protective factors to the occurrence of MACE (P<0.05). Conclusion:The HRV indexes indicating the sympathetic nervous system function can inflect the degree of coronary artery stenosis and assess the short-term prognosis in the AMI patients after PCI.

Key words: acute myocardial infarction, major adverse cardiac event, prognosis, percutaneous coronary intervention, heart rate variability

中图分类号: 

  • R654.2