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目的:探讨急性心肌梗死(AMI)患者心率震荡(HRT)现象的特征及其临床意义。方法:选择50例AMI患者(AMI组)及50例健康者(对照组)均接受24h动态心电图检查,分别计算HRT的2个参数震荡初始(TO)及震荡斜率(TS),并比较2组患者TO及TS均值,以及TO及TS异常的发生率。然后根据TO及TS是否异常将AMI组分为2个亚组:HRT异常组(TO或TS异常,二者均异常)及HRT正常组(TO及TS均正常),住院期间观察2个亚组复合心脏事件(包括室性心动过速、心室颤动、心力衰竭及死亡病例)发生率。结果:AMI组的HRT较对照组明显变钝(TO增加,TS减低),并且TO及TS异常发生率明显高于对照组。在AMI组中,HRT异常亚组的复合心脏事件发生率明显高于HRT正常亚组。结论:AMI组HRT变钝、TS减弱及TO增加可能成为评价AMI患者自主神经功能状态、预测恶性心律失常及心源性死亡的独立预测因素。
Objective: To investigate the characteristics and clinical significance of heart rate turbulence (HRT) in patients with acute myocardial infarction (AMI). Methods: Fifty patients with AMI (AMI group) and 50 healthy subjects (control group) underwent 24h Holter examination. Two parameters of HRT, oscillating onset (TO) and concussion slope (TS), were calculated and compared between two groups Patients TO and TS mean, as well as the incidence of TO and TS abnormalities. The AMI was then divided into 2 subgroups according to whether TO and TS were abnormal: HRT abnormal group (TO or TS abnormality, both abnormal) and HRT normal group (TO and TS were normal), 2 subgroups were observed during hospitalization Incidence of combined cardiac events (including ventricular tachycardia, ventricular fibrillation, heart failure, and deaths). Results: The HRT of AMI group was significantly blunted (increased TO and decreased TS) compared with control group, and the incidence of abnormal TO and TS was significantly higher than that of control group. In the AMI group, the incidence of composite cardiac events in the subnormal HRT subgroup was significantly higher than in the subnormal HRT subgroup. CONCLUSIONS: HRT dull, weakened TS, and TO increased in AMI patients may be independent predictors of functional status of autonomic nerves and prognosis of malignant arrhythmias and cardiogenic death in AMI patients.