不同部位急性心肌梗死患者的心律失常及心率变异性分析

发布时间：2018-07-10 09:18

本文选题：心律失常 + 动态心电图　；参考：《兰州大学》2017年硕士论文

【摘要】：背景:心律失常是急性心肌梗死(AMI)患者最常见的并发症之一,发生率约为75%-95%,其中恶性心律失常是心梗后早期的主要死因。动态心电图可连续记录24小时的心电数据,对于心律失常的检查至关重要。另外动态心电图还可测量AMI患者的心率变异性,评估自主神经功能。目的:研究不同部位AMI患者的心律失常表现特征及心率变异性。方法:纳入2015年至2016年就诊于兰州大学第一医院的AMI患者,按照不同部位分为非ST段抬高型心肌梗死(NSTEMI)组、下壁组及前壁组。分析住院期间动态心电图资料,对比各组间的心律失常发生情况及心率变异性指标。结果:共纳入239例AMI患者,其中前壁心梗105例(44%),下壁心梗68例(29%),NSTEMI 28例(11%),下壁右室心梗5例(2%),广泛前壁心梗16例(7%),下正后壁心梗5例(2%),高侧壁心梗2例(1%),前侧壁心梗8例(3%),前间壁心梗2例(1%)。在NSTEMI组、下壁组、前壁组中,频发室早[3(11%)vs.4(5%)vs.7(5%)]、Lown3级以上心律失常[6(21%)vs.14(18%)vs.29(22%)]及房性心律失常[26(93%)vs.73(94%)vs.117(88%)]发生率差异无统计学意义(P0.05),但NSTEMI[7(25%)]、下壁组[16(21%)]的缓慢性心律失常发生率高于前壁组[9(7%)],差异有统计学意义(P0.05)。单因素方差分析提示,全部窦性心搏RR间期的标准差(SDNN)、RR间期平均值的标准差(SDANN)、RR间期标准差的平均值(ASDNN)在三组间比较差异具有统计学意义(P0.05),进一步的LSD法两两比较发现前壁组中SDNN[(78.77±23.49)ms]、SDANN[(65.83±20.52)ms]、ASDNN[(40.83±14.00)ms]值均较NSTEMI组[(95.89±29.98)ms、(78.64±26.62)ms、(50.82±17.64)ms]、下壁组[(89.45±29.24)ms、(74.14±26.37)ms、(45.32±15.92)ms]下降。r MSSD、p NN50、LF、HF指标在三组间差异无统计学意义(P0.05)。结论:NSTEMI、下壁心肌梗死患者的缓慢性心律失常发生率较高。前壁心肌梗死的患者心率变异性损害程度较下壁心肌梗死、NSTEMI严重。
[Abstract]:Background: arrhythmia is one of the most common complications in patients with acute myocardial infarction (AMI). Dynamic electrocardiogram can record 24-hour ECG data continuously, which is very important for detecting arrhythmia. In addition, ambulatory electrocardiogram can measure heart rate variability and assess autonomic nervous function in AMI patients. Objective: to study the characteristics of arrhythmia and heart rate variability in patients with AMI. Methods: AMI patients who were admitted to the first Hospital of Lanzhou University from 2015 to 2016 were divided into non-ST-segment elevation myocardial infarction (NSTEMI) group, inferior wall group and anterior wall group according to different sites. The data of ambulatory electrocardiogram (ECG) during hospitalization were analyzed and the incidence of arrhythmia and heart rate variability (HRV) were compared. Results: 239 AMI patients were included. There were 105 cases of anterior wall myocardial infarction (44%), 68 cases of inferior wall myocardial infarction (29%), 28 cases of NSTEMI (11%), 5 cases of inferior right ventricular infarction (2%), 16 cases of extensive anterior wall myocardial infarction (7%), 5 cases of inferior posterior wall myocardial infarction (2 cases), 2 cases of high lateral wall myocardial infarction (1%), 8 cases of anterior lateral wall myocardial infarction (3%) and 2 cases of anterior wall myocardial infarction (1%). In NSTEMI group, inferior wall group, anterior wall group, There was no significant difference in the incidence of arrhythmias [6 (21%) vs.14 (18%) vs.29 (22%)] and atrial arrhythmias [26 (93%) vs.73 (94%) vs.117 (88%)] in the lower wall group (7 (25%), but the incidence of bradyarrhythmia in the lower wall group [16 (21%)] was higher than that in the anterior wall group [9 (7%)] (P0.05). Univariate analysis of variance suggested that The standard deviation (SDNN) of RR interval of all sinus beats (SDNN) and the standard deviation (SDANN) of RR interval (ASDNN) were significantly different among the three groups (P0.05). Further comparison of LSD method showed that SDNN [(78.77 卤23.49) Ms] SDANN [(65.83 卤20.52) Ms] was higher than ASDNN [(40.83 卤14.00) Ms] in anterior wall group. In NSTEMI group [(95.89 卤29.98) ms, () 78.64 卤26.62) ms, (50.82 卤17.64 Ms], the lower wall group [(89.45 卤29.24) ms, (74.14 卤26.37) ms, (45.32 卤15.92) Ms] decreased. Conclusion the incidence of bradyarrhythmia in patients with inferior myocardial infarction is higher than that in patients with lower myocardial infarction. The degree of heart rate variability damage in patients with anterior myocardial infarction was more serious than that in inferior wall myocardial infarction (NSTEMI).
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22;R541.7

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