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目的:探讨急性心肌梗死(acutemyocardialinfarction,AMI)早期溶栓治疗对心率变异性(heartratevariability,HRV)的影响。方法:264例首次Q波AMI患者按有无接受早期静脉溶栓治疗分为溶栓组119例、非溶栓组145例;溶栓组根据溶栓治疗成功与否又分为溶栓成功组68例和溶栓失败组51例。264例均在起病14日后行24小时动态心电图检查和HRV分析。结果:①溶栓成功组HRV时域分析指标24小时正常R-R间期的标准差、24小时内每5分钟节段平均正常R-R间期的标准差、24小时内每5分钟节段正常R-R间期标准差的平均值、连续正常R-R间期差值均方的平方根、差值超过50ms的R-R间期在一定时间内的百分比及频域分析指标总能谱、低能谱、高能谱均大于溶栓失败组和非溶栓组(P<0.01),溶栓成功组频域分析指标低能谱/高能谱比值小于溶栓失败组和非溶栓组(P<0.01);②溶栓失败组与非溶栓组所有HRV分析指标均无统计学差异(P>0.05)。结论:AMI早期溶栓治疗成功能改善病人的HRV,提示AMI早期梗死相关冠状动脉再通能提高心肌电稳定性。
Objective: To investigate the effect of early thrombolytic therapy on heart rate variability (HRV) in patients with acute myocardial infarction (AMI). Methods: 264 patients with first Q wave AMI were divided into thrombolytic group (119 cases) and non-thrombolytic group (145 cases) according to the presence or absence of early intravenous thrombolysis. Thrombolysis group was divided into thrombolytic group 68 cases and failed thrombolysis group of 51 cases. 264 cases were 14 days after the onset of 24-hour Holter examination and HRV analysis. Results: ① The HRV time-domain analysis of the successful thrombolysis group showed the standard deviation of the normal RR interval at 24 hours, the standard deviation of the average normal RR interval at every 5 minutes within 24 hours, the normal RR interval at 5 minutes in 24 hours Average of standard deviation of period, square root of mean square of continuous normal RR interval difference, percentage of RR interval with difference of more than 50 ms in a certain period of time, and total spectrum, low-energy spectrum and high-energy spectrum of frequency domain analysis index (P <0.01). The low-frequency / high-energy spectral ratio of the indicators of frequency domain analysis in the successful thrombolysis group was less than that of the thrombolytic failure group and the non-thrombolytic group (P <0.01) All HRV analysis indexes of non-thrombolysis group had no statistical difference (P> 0.05). Conclusion: The success of early thrombolytic therapy of AMI can improve the HRV of patients, suggesting that myocardial infarction-related coronary recanalization can improve cardiac electrical stability.