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目的探讨急性心肌梗死(AMI)患者的连续心率减速力(DRs)的变化,及其心率变异性指标如心率变异性总标准差(SDNN)之间的关系。方法选取AMI患者84例作为AMI组,及健康志愿者60例作为对照组,进行24h动态心电图检查,分别测定2组研究对象的DRs值(包括DR2、DR4和DR8)以及心率变异性指标,将AMI组与对照组按照DRs值的大小分为低危、中危、高危,比较2组中高危患者所占比例,并分析AMI组DRs值与SDNN的相关性。结果 AMI组DR4、DR8、SDNN均显著低于对照组(P<0.001),DR2的差异则无统计学意义(P>0.05);AMI组中预测到的中高危患者所占比例为40.5%明显高于对照组的3.3%,差异有统计学意义(P<0.001);DR2、DR4、DR8均与SDNN呈正相关。结论 DRs值可定量对AMI患者的迷走神经张力进行评估,且与SDNN正相关,或可作为临床预测AMI患者发生猝死的一个新指标。
Objective To investigate the changes of continuous heart rate deceleration (DRs) in patients with acute myocardial infarction (AMI) and the relationship between their heart rate variability indexes such as total heart rate variability (SDNN). Methods Eighty-four AMI patients were selected as AMI group and 60 healthy volunteers as control group. 24h dynamic electrocardiogram (ECG) was used to measure DRs (including DR2, DR4 and DR8) and heart rate variability The AMI group and the control group were divided into low risk, intermediate risk and high risk according to the size of DRs. The proportion of middle and high risk patients in two groups were compared, and the correlation between DRs and SDNN was analyzed. Results The levels of DR4, DR8 and SDNN in AMI group were significantly lower than those in control group (P <0.001), while there was no significant difference in DR2 between AMI group and AMI group (40.5%) Which was significantly higher than that of the control group (P <0.001). DR2, DR4 and DR8 were positively correlated with SDNN. Conclusions DRs can be used as a quantitative measure of vagal tone in patients with AMI and is positively correlated with SDNN or can be used as a new index for clinical prediction of sudden death in patients with AMI.