上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

急性心肌梗死患者心率变异的观察及敏感指标的探讨

张 颖1, 杨智昉2, 王 巍3, 李慈珍1, 刘远谋1, 王红卫1   

  1. 1.上海交通大学 基础医学院生理学教研室， 上海 200025； 2.上海医药高等专科学校 生理学教研室， 上海 201318； 3.上海交通大学 医学院附属瑞金医院老年病科, 上海 200025
  • 出版日期:2013-07-28 发布日期:2013-08-22
  • 作者简介:张 颖（1978—），女，硕士生; 电子信箱: fly0117@126.com。
  • 基金资助:

    上海市卫生局基金（2009045）；上海市科委基金（06JC14045）

Observation of heart rate variability in patients with acute myocardial infarction and detection of its sensitive index

ZHANG Ying1, YANG Zhi-fang2, WANG Wei3, LI Ci-zhen1, LIU Yuan-mou1, WANG Hong-wei1   

  1. 1.Department of Physiology, Basic Medical College, Shanghai Jiaotong University, Shanghai 200025, China; 2.Department of Physiology, Shanghai Institute of Health Sciences, Shanghai 201318, China; 3.Department of Geriatrics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
  • Online:2013-07-28 Published:2013-08-22
  • Supported by:

    Shanghai Municipal Health Bureau Foundation, 2009045; Shanghai Science and Technology Committee Foundation, 06JC14045

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摘要：

目的 观察心肌梗死患者入院即时和治疗前心率变异（HRV）的变化，并分析HRV各参数的敏感性。方法 采集正常人（正常对照组）、冠心病患者、急性心肌梗死（AMI）患者以及急性心肌缺血动物模型的心电图，进行短时程HRV分析。结果 与正常对照组比较，AMI患者除心率减慢外，其他HRV参数均显著增高，其中反映交感神经兴奋性的窦性心搏RR (N-N)间期的标准差（SDNN）、反映迷走神经张力的相邻RR (N-N)间期差值的标准差（SD of delta NN）、相邻RR (N-N)间期差值＞50 ms个数占RR间期总数的百分比（NN50）和poincare散点图短轴参数SD1分别为正常对照组的1.8、2.7、7.5和3.1倍。用垂体后叶素诱发动物产生急性心肌缺血后，HRV的变化也呈类似改变。与正常对照组比较，冠心病患者的HRV各参数减小，其中SDNN和SD of delta NN与正常对照组差异无统计学意义（P>0.05），但SD1则明显减小（P<0.01）。结论 AMI时HRV参数显著增大，慢性稳定型冠心病的HRV参数较正常人减小。用HRV判断自主神经活动变化时，SD1优于其他HRV参数。

关键词: 心率变异, 心电图, 急性心肌梗死, 急性心肌缺血模型

Abstract:

Objective To observe the heart rate variability (HRV) at admission and before treatment in patients with myocardial infarction. Methods Electrocardiograms were recorded from healthy people, patients with coronary heart disease, patients with acute myocardial infarction and acute experimental ischemia animals, and shorttime HRV analysis was performed. Results Except for the heart rate, the other indexes of HRV in patients with acute myocardial infarction were significantly higher than those in healthy people, and SDNN (standard deviation of normal to normal RR intervals, representative of sympathetic tone), SD of delta NN (standard deviation of successive differences between adjacent normal cycles), NN50 (the percent of time that the difference between adjacent normal RR intervals was greater than 50 ms) and minor axis of poincare plot (SD1) which stood for parasympathetic tone, increased by 1.8, 2.7, 7.5 and 3.1 times respectively compared with healthy people. Those changes were also observed in the animal model with acute myocardial ischemia evoked by hypophysin. In comparison with healthy people, the HRV indexes of patients with coronary heart disease decreased substantially, although SDNN and SD of delta NN did not change significantly （P>0.05）, SD1 decreased significantly (P<0.01). Conclusion HRV indexes in patients with acute myocardial infarction would elevate significantly. Compared with healthy people, on the other hand, the patients with chronic coronary heart disease exhibit decreased HRV indexes. In all probability, SD1 is more useful in evaluation of the changes in autonomic nervous activities than the other HRV indexes.

Key words: heart rate variability, electrocardiogram, acute myocardial infarction, animal model of acute myocardial ischemia