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目的 探讨急性心肌梗死 (AMI)恢复期梗死相关冠状动脉 (IRCA)再通对心率变异性 (HRV)的影响。方法 对6 3例AMI患者于发病 2～ 6周行冠状动脉造影术 ,其中 36例接受经皮冠状动脉腔内成形术 (PTCA) ,34例成功。所有患者均于术前 1周内及术后 3个月、6个月、12个月行 2 4小时动态心电图记录并测定HRV各项指标。结果 所有患者AMI早期HRV均显著降低 (P <0 0 1) ,术后 3个月明显恢复 (P <0 0 5 ) ,而术后 12个月时仍低于正常 (P <0 0 5 )。但在PTCA组 ,HRV各指标于术后 6个月及 12个月时进一步明显改善 (P <0 0 5 ) ,而非PTCA组则无明显改善 (P >0 0 5 )。结论 AMI恢复期IRCA再通可以改善患者的HRV ,而这一作用对患者远期生存率的预测价值尚待大规模临床试验进一步评价。
Objective To investigate the effect of recanalization of infarct-related coronary artery (IRCA) on heart rate variability (HRV) during the recovery of acute myocardial infarction (AMI). Methods Sixty-three AMI patients underwent coronary angiography 2 to 6 weeks after their onset. Among them, 36 cases underwent percutaneous transluminal coronary angioplasty (PTCA) and 34 cases were successful. All patients were recorded within 24 hours after operation within 1 week and 3 months, 6 months and 12 months after operation. HRV indexes were recorded and measured. Results All patients had significantly lower HRV in the early stage of AMI (P <0.01) and recovered significantly at 3 months (P <0.05), but still lower than normal at 12 months after operation (P <0 05) . However, in the PTCA group, the HRV indexes were further improved at 6 months and 12 months after operation (P <0.05), but not in the PTCA group (P> 0.05). Conclusions IRCA recanalization during AMI convalescence can improve the HRV of patients, and the predictive value of this effect on the long-term survival of patients remains to be further evaluated in large-scale clinical trials.