心率减速力及连续心率减速力对冠心病心脏性猝死的预警价值

摘要

Objective:To make risk stratification of aged patients with coronary artery disease by deceleration capacity of rate (DC) and heart rate deceleration runs (DRs) and to investigate the value of the two detection technologies in warning sudden cardiac death.Methods:Two hundrend and eighteen patients diagnosed with coronary artery disease (CAD) by coronary angiography (CAG) were selected as observation group:including 55 patients with latent coronary artery disease (LCHD),56 patients with acute myocardial infarction (AMI),53 patients with angina pectoris (AP),54 patients with ischemic heait failure.Fifty-five healthy controls in our hospital were selected at the same time (control group).All patients were detected by 24-hour dynamic electrocardiogram while values of DC and DRs were automatically analyzed and calculated by software.Results:The values of DC and DRs descended significantly in all CHD groups (AMI group,AP group,Ischemic Heart Failure group,LCHD group) and the difference was statistically significant (P ＜ 0.01) compared with normal group;DC and DRs indicated the risk classification of each CAD subgroup was obviously higher than those in normal group and the difference was statistically significant(P ＜ 0.01);CAG showed that the more coronary lesions,the larger the rage,prompt the heavier the illness,which was consistent with the risk classification of each CHD subgroup indicated by DC and DRs.Conclusion:DC and DRs can be used to analyze the function of vagus nerve,it also can be used to make risk classification of patients with CHD,and it has a higher value of pre-warning for high-risk groups.DC and DRs can be used as sensitive indexes in warning sudden cardiac death of patients with CHD.%目的:通过心率减速力(DC)及连续心率减速力(DRs)检测技术对老年冠心病患者进行风险分层,探讨其对心脏性猝死的预警价值.方法:随机选择经冠状动脉造影(CAG)确诊为冠心病(CHD)的患者218例作为观察组,其中隐匿性CHD 55例,急性心肌梗死(AMI)56例,心绞痛(AP)53例,缺血性心力衰竭(IHF)54例.同期选取在本院进行健康体检者55例(对照组),对各组患者行24h动态心电图检查,应用软件系统分析并计算出DC值及DRs值进行统计分析.结果:CHD各亚组(AMI组、AP组、IHF组、隐匿性CHD组)的DC值及DRs值均明显降低,与正常组比较,差异有统计学意义(P＜0.01);DC值与DRs值所提示CAD各亚组的危险分级明显高于正常组,差异有统计学意义(P＜0.01);冠状动脉造影显示冠脉病变数量越多范围越大,病情越重,这与DC、DRs所提示CHD各亚组的危险分级相一致.结论:心率减速力和连续心率减速力能够测定分析迷走神经功能,对冠心病患者进行危险分级,对高危人群有较高的预警价值,可作为预警冠心病患者发生心脏性猝死的敏感指标.