急性心肌梗死患者直接经皮冠状动脉介入治疗前后窦性心律振荡的临床观察

探讨急性心肌梗死（AMI）患者直接经皮冠状动脉介入（PCI）前后窦性心律振荡（HRT）的变化及意义.选择伴室性早搏的AMI患者（观察组）和无器质性心脏病的室性早搏患者（对照组）各42例,PCI前伴室早的观察组患者,用节律Ⅱ导联记录室早的心电图,PCI后2周时观察组及对照组均记录24h动态心电图（AECG）,计算其震荡初始（TO）和震荡斜率（TS）,并行心脏彩色多普勒超声检查,测定左室射血分数（LVEF）.结果观察组PCI后2周时和对照组LVEF分别为：（59.1＆#177;7.5）%和（61.3＆#177;8.4）%.观察组PCI前TO显著升高,TS显著降低,差异有统计学意义（P＜0.05）;观察组PCI后2周TO较前降低,TS较前升高,但和对照组相比差异仍有统计学意义（P＜0.05）;观察组PCI后2周时和对照组左室射血分数（LVEF）相比无差异.提示AMI患者HRT减弱,PCI后2周HRT改善但和观察组相比仍有统计学意义,提示AMI患者PCI后早期仍存在心脏自主神经功能下降,HRT可作为评价AMI患者预后的一个指标.

Clinical Observation of Sinus Heart Rate Turbulence in Acute Myocardial Infarction Patients Before and After Direct Percutaneous Coronary Intervention

To investigate change and significance of sinus heart rate turbulence in Acute myocardial infarction （AMI） patients before and after directly percutaneous coronary intervention （PCI）. Select 42 AMI patients with premature ventricular contraction（observation group）and 42 premature ventricular contraction patients without organic heart disease（control group）. Record premature ventricular contraction ECG of observation group patients before PCI with rhythm lead II. Record 24 hours Holter of observation group patients 2 weeks after PCI and patients in control group. Calculate the turbulence onset （TO） and turbulence slope （TS） and examine Doppler echocardiography to determine left ventricular ejection fraction（LVEF）. TO in observation group before PCI was significantly higher than that in control group （P〈0.05） ;TS in observation group before PCI was significantly lower than that in control group （P〈0.05）. TO in observation group 2 weeks after PCI was lower than before, and TS in observation group 2 weeks after PCI was higher than before, while compare with control group, there were significant differences（P〈0.05）. There was no significant difference between LVEF in observation group 2 weeks and LVEF in control group. HRT are decreased in AMI patients. 2 weeks after PCI HRT in observation group are improved but still have significant differences compared with those control group. Prompt that decreased cardiac autonomic function exists in AMI patients after PCI. HRT may become one predictor to evaluate prognosis of AMI patients.