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目的探讨冠心病患者心绞痛,心脏性猝死(SCD)与心率变异性(HRV)、窦性心率振荡(HRT)、QT离散度(QTcd)、心室晚电位(VLP)的相关性,给于极化液,美托洛尔治疗,观察其对自主神经功能失衡与SCD的疗效。方法选择冠心病患者300例,行24h动态心电图检查,测定心率变异性(HRV),窦性心率振荡(HRT)参数,振荡起始(TO)和振荡斜率(TS),心电图测量校正QT离散度(QTcd),多信息心电检测心室晚电位(VLP),超声心动图检测左心室射血分数(LVEF)。对HRT与HRV、LVEF、QTcd、VLP等进行比较分析及治疗前后对照研究。结果①冠心病心绞痛患者HRV指标昼夜变化比较,对照组HRV表现出昼夜节律性变化,夜晚较白昼夜高,觉醒前达峰值,醒后迅速下降。冠心病心绞痛患者HRV昼夜规律被破坏,表现为昼夜变化消失。以冠心病组(UA)145例更为明显(p<0.01)。②发生SCD 21例,HRV分析值均明显下降(p<0.01),HRT减低、QTcd延长、VLP阳性率增高(p<0.01),同时心率明显增快(p<0.01)。③GIK联合美托洛尔治疗后心率变异频域指标明显改善,p<0.01。治疗组不稳定性心绞痛、室性心律失常、心脏性死亡及心力衰竭的发生率较对照组减少(p<0.01)。结论冠心病不稳定性心绞痛患者存在自主神经功能紊乱,是发生SCD的高危人群,HRV、HRT、QTcd、VLP是的对冠心病患者进行危险度分层及病死率的预测的良好指标。极化液、美托洛尔能阻断交感活性对心脏的不良作用,纠正冠心病患者的自主神经失衡,有效地改善心功能,降低病死率,从而减少心律失常及猝死的发生。
Objective To investigate the correlation between SCD and heart rate variability (HRV), sinus rhythm heart rate (HRT), QT dispersion (QTcd) and ventricular late potentials (VLP) in patients with coronary heart disease Liquid, metoprolol treatment, observed its autonomic dysfunction and SCD efficacy. Methods 300 patients with coronary heart disease (CHD) were enrolled in this study. HRV, HRT, TS and TS were measured by 24 hour electrocardiogram. The QT dispersion was corrected by electrocardiogram (QTcd), multi-information ECG to detect ventricular late potentials (VLP) and echocardiography to detect left ventricular ejection fraction (LVEF). The HRT and HRV, LVEF, QTcd, VLP and other comparative analysis and before and after treatment control study. Results ① Comparison of diurnal changes of HRV index in patients with coronary heart disease and angina pectoris showed HRV showed a circadian rhythmic change in night, night before night, peak before awakening and then decreased rapidly. HRV circadian rhythm of patients with coronary heart disease was destroyed, showing the disappearance of diurnal changes. The coronary heart disease group (UA) 145 cases were more obvious (p <0.01). (2) The incidence of SCD in 21 cases was significantly lower (p <0.01), HRT was lower, QTcd was prolonged, the positive rate of VLP was higher (p <0.01) and the heart rate was significantly higher (p <0.01). ③GIK combined with metoprolol treatment of heart rate variability significantly improved the frequency domain, p <0.01. The incidence of unstable angina, ventricular arrhythmia, cardiac death and heart failure in the treatment group was lower than that in the control group (p <0.01). Conclusions Autonomic nervous dysfunction occurs in patients with unstable angina pectoris and is a high risk group of patients with SCD. HRV, HRT, QTcd and VLP are good predictors of risk stratification and mortality in patients with coronary heart disease. Polaroid fluid, metoprolol can block the sympathetic activity of the adverse effects on the heart, correct the autonomic imbalance in patients with coronary heart disease, effectively improve cardiac function, reduce mortality, thereby reducing the incidence of arrhythmia and sudden death.