Boghossian S H, Maia I G, Costa Filho R, Alves P A
Hospital Pró-Cardíaco, Rio de Janeiro.
Arq Bras Cardiol. 1992 Nov;59(5):365-8.
To analyse the effects of thrombolysis on the integrity of the autonomic nervous system, in patient with acute myocardial infarction (AMI) of the anterior wall, using the determination of the heart rate variability.
We prospectively evaluated the R-R variability of the 31 consecutive patients with anterior AMI submitted to coronary thrombolysis (25 males; mean age 59 +/- 14 years) from Holter tapes. An algorithm in a 286 computer program was used for heart rate variability (HRV). With this system, R-R variations during sinus rhythm and for a five consecutive minutes periods was determined. The results were expressed as the mean of the total determined periods; the standard deviation of the mean of all determined periods and the mean of the standard deviation. The reperfusion criteria was the early enzymatic rise of the CKMB activity levels (< or = 12 h) combined with a 50% or more reduction in the ST segment elevation within the first hour after thrombolytic therapy and the presence of an accelerated idioventricular rhythm at the same time. The reperfused group (group 1 = 16 patients) and non-reperfused group (group 2 = 15 patients) were compared in terms of R-R variability.
Mean R-R: group 1 = 716 +/- 84 ms (540-820 ms); group 2 = 595 +/- 115 ms (390-870 ms)-p < 0.02. ms (34-92 ms); group 2 = 50 +/- 14 ms (23-77 ms)-p < 0.01. HRV 50 ms: group 1 = 2 patients; group 2 = 5 patients. Means SD of the R-R: group 1 = 44 +/- 14 ms (26-65 ms); group 2 = 39 +/- 17 ms (19-69 ms)-p: ns.
Patients with anterior AMI and thrombolytic therapy demonstrate greater HRV; this finding suggested better integrity of the autonomic nervous system, with possible effects on prognosis.
通过测定心率变异性，分析溶栓治疗对前壁急性心肌梗死（AMI）患者自主神经系统完整性的影响。
我们前瞻性评估了31例接受冠状动脉溶栓治疗的连续性前壁AMI患者（25例男性；平均年龄59±14岁）动态心电图记录的RR间期变异性。使用286计算机程序中的一种算法来测定心率变异性（HRV）。通过该系统，测定窦性心律期间以及连续5分钟时段的RR间期变化。结果以所有测定时段的平均值、所有测定时段平均值的标准差以及标准差的平均值表示。再灌注标准为CKMB活性水平早期酶学升高（≤12小时），同时溶栓治疗后第一小时内ST段抬高降低50%或更多，且同时存在加速性室性自主心律。比较再灌注组（第1组 = 16例患者）和未再灌注组（第2组 = 15例患者）的RR间期变异性。
平均RR间期：第1组 = 716±84毫秒（540 - 820毫秒）；第2组 = 595±115毫秒（390 - 870毫秒） - p < 0.02。毫秒（34 - 92毫秒）；第2组 = 50±14毫秒（23 - 77毫秒） - p < 0.01。HRV 50毫秒：第1组 = 2例患者；第2组 = 5例患者。RR间期的平均标准差：第1组 = 44±）14毫秒（26 - 65毫秒）；第2组 = 39±17毫秒（19 - 69毫秒） - p：无显著差异。
接受溶栓治疗的前壁AMI患者表现出更大的HRV；这一发现提示自主神经系统完整性更好，可能对预后有影响。
