摘要
目的研究ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者自主神经在再灌注治疗前后心律失常中作用。方法选取2015年8月至2016年11月在解放军中部战区总医院心内科住院诊断为STEMI,发病24 h内急诊经皮冠状动脉介入治疗的患者104例,男84例,女20例,年龄(57.9±11.4)岁。采用血压、心率变化评估自主神经活性,通过心电监护记录再灌注前后心律失常,观察STEMI患者再灌注前后自主神经功能变化与心律失常的关系。结果急性心肌梗死后存在自主神经失衡,包括交感神经过度兴奋和迷走神经过度兴奋,总失衡率约31.7%,自主神经功能失衡患者心律失常发生率明显高于无明显失衡患者,差异有统计学意义(42.4%vs. 7.0%,P<0.05)。再灌注治疗后患者仍存在自主神经失衡,迷走神经过度兴奋患者再灌注心律失常发生率增高,高于自主神经无明显失衡患者,差异有统计学意义(71.4%vs. 23.3%,P<0.05)。经皮冠状动脉介入治疗再灌注后自主神经功能急剧变化,主要表现为迷走神经功能增强,占38.9%,而交感神经活性增强者仅占1.1%,迷走神经功能增强与再灌注心律失常相关,迷走神经功能明显增强、轻度增强患者再灌注心律失常发生率高于自主神经功能无明显改变患者,差异有统计学意义(64.7%vs. 20.4%,P<0.05;44.4%vs. 20.4%,P<0.05)。结论 STEMI患者再灌注前后存在明显自主神经失衡,自主神经失衡与再灌注前后心律失常相关,再灌注治疗过程中迷走神经功能的急剧增强与再灌注心律失常相关。
Objectives To investigate the role of autonomic nerve function in arrhythmias in patients with acute ST segment elevation myocardial infarction(STEMI)before and after reperfusion therapy.Methods Totally 104 patients with STEMI were treated with percutaneous coronary intervention within 24 hours of the onset of acute myocardial infarction from August 2015 to November 2016 in Central War Zone General Hospital of PLA.There were 84 males and 20 females,with an average age of(57.9±11.4)years.The autonomic nervous activity was evaluated by blood pressure and heart rate changes,and the arrhythmia was recorded by electrocardiogram(ECG)monitoring before and after reperfusion.Relationship between autonomic nerve function changes and arrhythmia before and after reperfusion therapy It was analyzed.Results There were autonomic imbalance after acute STEMI including sympathetic overactivity and vagal overactivity.The total rate of autonomic imbalance was 31.7%.The incidence of arrhythmia in patients with autonomic imbalance was significantly higher than that in patients without obvious imbalance(42.4%vs.7.0%,P<0.05).The incidence of reperfusion arrhythmia was significantly higher in vagal overactivity than that in patients with no obvious imbalance(71.4%vs.23.3%,P<0.05)after percutaneous coronary intervention.The autonomic nerve function changes quickly after percutaneous coronary intervention reperfusion therapy,especially vagus nerve function enhancement was 38.9%,while sympathetic neural activity enhancement was only 1.1%.Reperfusion arrhythmia increased significantly in vagus nerve function enhancement group and mild enhancement group than in no obvious change group(64.7%vs.20.4%,P<0.05;44.4%vs.20.4%,P<0.05).Conclusions There is obvious autonomic nerve imbalance before and after reperfusion in patients with STEMI.The imbalance of autonomic nervous system is related to arrhythmia before and after reperfusion.The rapid increase of vagus nerve function during reperfusion is related to reperfusion arrhythmia.
作者
蒋桔泉
宋麒麟
丁世芳
姜其钧
林锋
刘燕
马昌榕
JIANG Ju-quan;SONG Qi-lin;DING Shi-fang;JIANG Qi-jun;LIN Feng;LIU Yan;MA Chang-rong(Department of Cardiology,Central War Zone General Hospital of PLA,Wuhan 430070,China;Departmentof Cardiology,Xiangzhou District People′s Hospital,Xiangyang,Hubei 441000,China)
出处
《岭南心血管病杂志》
2019年第1期68-71,79,共5页
South China Journal of Cardiovascular Diseases
基金
湖北省卫计委资助项目(WJ2017M159)
