论文部分内容阅读
目的:回顾性的分析窦性心率震荡现象(Heart Rate Turbu lence,简称HRT)对老年人(≥60岁)急性心肌梗死后再发心脏事件(再次心肌梗死、再次心绞痛、恶性心律失常、心衰和猝死)的影响。方法:选择自1997年2月至2004年12月的首次因急性心肌梗死入院的患者405例,其中急性心肌梗死后2到3周内有室性早搏(室早)并且在24小时动态心电图(Holter)或监护导联上能记录到室早前有至少3个正常的窦性心搏,室早后有连续20个以上窦性心搏,且年龄≥60岁的病人204例。记录可能影响预后的相关指标,包括年龄、性别、吸烟、高血压、血脂异常、糖尿病、家族史、尿酸升高、急性心肌梗死部位、采取治疗措施、左室射血分数(均采用面积长轴法)、心肌梗死二级预防用药(ACE I、Asp irin、Statin、β-B lockor等)以及HRT分类。HRT 0为窦性心率震荡初始(TO)<0并且窦性心率震荡斜率(TS)>2.5 m s/RR I(RRInterval);HRT 1为TO≥0或者TS≤2.5 m s/RR I;HRT 2为TO≥0并且TS≤2.5 m s/RR I。结果:204例男98例,年龄(70.55±6.65)岁;女106例,年龄(70.93±6.28)岁,平均随访(22±12.3)个月,其中因再发心脏事件二次入院的78例,入院后死亡的21例,随访期内院外死亡的16例。Logistic多元回归分析显示老年人急性心肌梗死后再发心脏事件与HRT、糖尿病、LVEF≤55%及吸烟显著相关,其相对危险系数分别为18.915(P<0.001)、11.865(P=0.001)、6.444(P=0.011)及4.905(P=0.043)。结论:窦性心率震荡现象是老年人急性心肌梗死后再发心脏事件良好的预测指标。
Objective: To retrospectively analyze the impact of sinus rate heart rate (HRT) on the incidence of recurrent myocardial infarction, reoccurrence of angina pectoris, malignant arrhythmia and heart failure after acute myocardial infarction in the elderly (≥60 years) And sudden death). METHODS: A total of 405 hospitalized patients admitted for acute myocardial infarction from February 1997 to December 2004 were selected, with premature ventricular contractions (ventricular premature) within 2-3 weeks after acute myocardial infarction and 24-hour ambulatory electrocardiography Holter or guardianship leads can record that there were at least 3 normal sinus beats earlier in the room, 204 consecutive patients with more than 20 consecutive sinus beats and more than 60 years of age. Record the relevant indicators that may affect the prognosis, including age, gender, smoking, hypertension, dyslipidemia, diabetes, family history, elevated uric acid, acute myocardial infarction, treatment measures, left ventricular ejection fraction France), secondary prevention of myocardial infarction (ACE I, Asp irin, Statin, β-B lockor, etc.) and HRT classification. HRT 0 was initial sinus heart rate (TO) <0 and sinus rhythm was> 2.5 ms / RR I (RRInterval); HRT 1 was TO ≥ 0 or TS ≤ 2.5 ms / RR I; HRT 2 was TO ≧ 0 and TS ≦ 2.5 ms / RR. Results: There were 98 male patients (70.55 ± 6.65) and 106 female patients (70.93 ± 6.28) years old with an average follow-up of (22 ± 12.3) months, of whom 78 were secondary hospitalized for recurrent cardiac events , 21 died after admission, and 16 died in hospital during the follow-up period. Logistic multivariate regression analysis showed that the relapse of cardiac events after AMI in the elderly was significantly associated with HRT, diabetes, LVEF≤55% and smoking, with relative risk factors of 18.915 (P <0.001), 11.865 (P = 0.001), 6.444 (P = 0.011) and 4.905 (P = 0.043). CONCLUSIONS: Sinusoidal heart rate turbulence is a good predictor of cardiac events after acute myocardial infarction in the elderly.