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目的本研究目的在于探讨性窦心率震荡(HRT)预测陈旧性心肌梗死(OMI)后发生心力衰竭的价值。方法对192例有完整资料的OMI患者进行回顾性分析,将其分为:A组(合并心力衰竭)和B组(无心力衰竭),选择年龄、性别相匹配的无心肌梗死病史的90例患者作对照组。根据动态心电图结果分析HRT指标震荡初始(TO)、震荡斜率(TS)和静息心率(RHR)、正常心动周期标准差(SDNN)。利用超声心动图对OMI患者进行心功能评价,测量左室射血分数(LVEF)和左室舒张末期内径(LVEDD)。分析HRT指标和SDNN、RHR、LVEF、LVEDD的相关性。结果 1A组TO和TS与B组及对照组比较,均有统计学差异(p<0.05),B组TO和TS均在正常范围内,但与正常对照组比较仍有统计学差异;2A组LVEF、LVEDD、SDNN、RHR均与B组及对照组具有显著的统计学差异(p<0.05);3相关性分析显示TO与SDNN呈负相关,但TO和其他因素无明显相关性,TS与SDNN和LVEF呈正相关,而与LVEDD和RHR呈负相关。结论 HRT尤其是量化的TS能更好地预测OMI患者合并心力衰竭的风险,对于降低梗死后心力衰竭的发生率、改善预后和降低死亡率具有重要的临床应用价值。
Objectives The purpose of this study was to explore the value of sinusoidal heart rate turbulence (HRT) in prediction of heart failure after obstructive myocardial infarction (OMI). Methods A total of 192 OMI patients with complete data were retrospectively analyzed and divided into A group (with heart failure) and B group (without heart failure), 90 patients with no history of myocardial infarction with age and gender matched Patients as control group. According to the results of Holter, HRT indexes such as initial oscillatory (TO), concussion slope (TS) and resting heart rate (RHR), normal cardiac cycle standard deviation (SDNN) were analyzed. Cardiac function was evaluated by echocardiography in patients with OMI. Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) were measured. The correlation between HRT index and SDNN, RHR, LVEF and LVEDD was analyzed. Results The TO and TS values in group 1A were significantly different from those in group B and control (p <0.05). The levels of TO and TS in group B were within the normal range, but there were still significant differences between group A and group B There was significant difference between LVEF, LVEDD, SDNN and RHR in group B and control group (p <0.05); 3 The correlation analysis showed that TO and SDNN were negatively correlated, but TO and other factors had no significant correlation SDNN and LVEF were positively correlated, but negatively correlated with LVEDD and RHR. Conclusion HRT, especially quantified TS, can better predict the risk of heart failure in patients with OMI. It has important clinical value for reducing the incidence of post-infarction heart failure, improving prognosis and reducing mortality.