目的 通过对急性冠脉综合征（ACS）患者围术期窦性心率震荡（HRT）及心率变异性（HRV）的检测及随访，观察主要心血管事件（MACE）的发生情况，探讨HRT和HRV对ACS患者预后的预测作用。方法 采用前瞻性方法入组确诊为ACS并接受冠状动脉造影（CAG）和经皮冠状动脉介入（PCI）治疗的患者167例，于发病2～4周内采用美国Delmar动态心电检测系统行24 h动态心电图检查，以参数震荡初始（TO）和震荡斜率（TS）评价HRT，以连续24 h内正常RR间期的标准差（SDNN）评价HRV。随访时间≥5个月，观察患者MACE的发生情况。结果 HRT异常组51例，发生MACE 7例（13.73%）；HRT正常组59例，发生MACE 7例（11.85%）；两组MACE发生率比较差异无统计学意义（P>0.05）。HRT预测ACS患者MACE的敏感度和特异度分别为50.0%和54.2%，准确度为53.6%；HRV预测ACS患者发生MACE的阳性预测值和阴性预测值分别为9.1%和92.4%，SDNN降低与ACS患者发生MACE有关（P<0.05）。结论 围术期进行24 h动态心电图检查十分必要，HRV的降低对ACS患者预后有重要预测价值，而HRT的预测价值有限。

Objective To observe the major adverse cardiac events (MACE) and to explore the predictive effects of sinus heart rate turbulence (HRT) and heart rate variability (HRV) on the prognosis of patients with acute coronary syndrome (ACS) through the perioperative detection and follow-up. Methods The prospective method was used for 167 patients who were diagnosed with ACS and underwent coronary angiography (CAG) and percutaneous coronary intervention (PCI) treatment. Delmar dynamic ECG detection system (USA) was used to give 24 h dynamic electrocardiogram examination for each patient within 2-4 weeks of onset. The HRT was evaluated by the turbulence onset (TO) and turbulence slope (TS) and the HRV was evaluated by the standard deviation of consecutive 24 h normal RR interval (SDNN). The followup was continued for at least 5 months and the occurrence of MACE was observed. Results There were 51 cases of abnormal HRT, among which 7 were with MACE (13.73%). Among 59 cases of normal HRT, 7 cases were with MACE (11.85%). The differences of the occurrence rate of MACE between patients with abnormal HRT and normal HRT were not statistically significant (P>0.05). The sensitivity, specificity, and accuracy of prediction of MACE for patients with ACS by the HRT were 50.0%, 54.2%, and 53.6%, respectively. The positive value and negative value of prediction of MACE for patients with ACS by the HRV were 9.1% and 92.4%, respectively. Decreased SDNN was relevant to the occurrence of MACE (P<0.05). Conclusion The perioperative 24-hour dynamic electrocardiogram examination is critical. Reduced HRV is important for predicting the prognosis of patients with ACS, while the predictive value of HRT is limited.