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目的观察PCI术对急性冠脉综合征患者心率震荡(HRT)与心率变异性(HRV)的影响。方法选择接受PCI的ACS患者126例,按冠脉造影结果分为中度狭窄(管腔直径狭窄70%～90%)及重度狭窄(管腔直径狭>90%)组。分析其PCI术前及术后1周、3个月HRT指标震荡初始(TO)、震荡斜率(TS)及HRV指标(SDNN、SDANN及RMSSD)。结果 PCI术后1周HRT较术前明显改善(p<0.01);HRV参数与术前比较无显著差异(p>0.05)。PCI术后3个月,HRT较术前明显改善(p<0.01)但与术后1周无显著差异(p>0.05);HRV参数较术前及术后1周均明显降低(p<0.01)。PCI术前重度狭窄组TO值较中度狭窄者升高(p<0.05),TS值较中度狭窄者明显降低(p<0.01),而SDNN、SDANN及RMSSD均较中度狭窄者明显降低(p<0.01)。PCI术后3个月重度狭窄组HRT及SDNN、SDANN、RMSSD与中度狭窄组比较仍有显著差异性(p<0.05)。结论 HRT及HRV异常与ACS患者病情的严重程度密切相关。HRT及HRV对急性冠脉综合征再灌注治疗后血流的恢复情况具有近期及远期预测价值,可望在临床上做为一种有效无创方法评价PCI的疗效及预后。
Objective To observe the effects of PCI on heart rate turbulence (HRT) and heart rate variability (HRV) in patients with acute coronary syndrome. Methods One hundred and sixty-six patients with ACS undergoing PCI were divided into two groups: moderate stenosis (70% -90% of the diameter of the lumen) and severe stenosis (> 90% of the diameter of the lumen). The HRT indexes (TO, Oscillation slope (TS) and HRV indexes (SDNN, SDANN and RMSSD) were analyzed before PCI and 1 week and 3 months after PCI. Results HRT was significantly improved 1 week after PCI (p <0.01). There was no significant difference in HRV between the two groups (p> 0.05). At 3 months after PCI, HRT was significantly improved compared with that before operation (p <0.01), but not significantly different from that at 1 week after operation (p> 0.05); HRV was significantly lower than preoperative and postoperative one week (p <0.01) ). Compared with moderate stenosis, TS value of severe stenosis group was significantly higher than that of moderate stenosis group (p <0.05), TS value was significantly lower than moderate stenosis group (p <0.01), while SDNN, SDANN and RMSSD were significantly lower than moderate stenosis group (p <0.01). HRT and SDNN, SDANN, RMSSD in severe stenosis group at 3 months after PCI were still significantly different from those in moderate stenosis group (p <0.05). Conclusion The abnormal HRT and HRV are closely related to the severity of ACS patients. HRT and HRV have predictive value in the near future and long-term prognosis of the recovery of blood flow after reperfusion of acute coronary syndrome. It is expected to evaluate the efficacy and prognosis of PCI in clinical practice as an effective non-invasive method.