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急性心肌梗死后心律失常与心脏自主神经活性密切相关,目前强调心肌梗死后交感神经过度激活与失衡。实际上由于心脏自主神经复杂性,不同时段、不同部位梗死造成自主神经失衡可能并不一样,对其仍缺乏全面了解。笔者认为急性心肌梗死后应分时段、分区域研究自主神经失衡,提出三时段、三区域模型,将心肌梗死后分为早期刺激期、神经坏死期和神经重构期;根据梗死血管分为前降支区域、回旋支区域、右冠区域。此有利于全面了解心肌梗死自主神经活性,合理解释心肌梗死后不同临床表现,理清自主神经研究的思路,阐明自主神经在再灌注心律失常中的作用机制,更好地有针对性地采取相应措施,纠正自主神经失衡,指导临床治疗。
Arrhythmia after acute myocardial infarction and cardiac autonomic nervous activity are closely related to the current emphasis on post-myocardial infarction sympathetic over-activation and imbalance. In fact due to the complexity of cardiac autonomic nervous system, autonomic imbalance caused by infarction at different time points and different parts may not be the same, which still lacks comprehensive understanding. I believe that after acute myocardial infarction should be sub-time and sub-regional study of autonomic imbalance, proposed three periods, three regional models, the myocardial infarction is divided into early stimulation, necrosis and neural reconstruction phase; according to the infarction vessels into the former Descending branch area, circumflex area, right crown area. This is conducive to a comprehensive understanding of myocardial infarction autonomic nervous activity, a reasonable explanation of different clinical manifestations after myocardial infarction, clear autonomic nervous system research ideas to clarify the role of autonomic nervous system in reperfusion arrhythmia, and better targeted to take the appropriate Measures to correct the imbalance of autonomic nervous, guiding clinical treatment.