急性冠脉综合征患者介入治疗术后非杓型心率与预后的关系被引量：4

Relationship between non-dipper night rate and prognosis of patients with acute coronary syndrome after percutaneous coronary intervention

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摘要目的探讨急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）术后非杓型心率与预后的关系.方法根据出院后4～6周24 h动态心电图检查结果,将470例行PCI的ACS患者分为非杓型心率组202例和杓型心率组268例.所有患者出院后均常规服用抗血小板聚集和他汀类等药物,出院后4～6周行24 h动态心电图检杏,两组患者均随访12个月以上.结果非杓型心率组患者的年龄、陈旧性心肌梗死和多支病变患者比例均高于杓型心率组,出院前1天的左室射血分数低于杓型心率组（P＜0.05）;其余一般资料比较差异均无统计学意义（P＞0.05）.非杓型心率组患者入院时静息心率、夜间平均心率、高频功率/低频功率明显高于杓型心率组,白天平均心率、夜间心率下降幅度、24h全部窦性心搏RR间期的标准差（SDNN）均低于杓型心率组（P＜0.05）,而两组患者出院时静息心率、24h平均心率、全程相邻窦性心搏RR间期差值的平方根（RMSSD）、相邻RR间期相差＞50 ms的心搏数占总心搏数的百分比（PNN50）及随访时间比较,差异均无统计学意义（P＞0.05）;随访期间非杓型心率组主要不良心脏事件总发生率、心源性死亡率、非致死性心肌梗死和靶血管再次血运重建发生率、再次住院率均明显高于杓型心率组（P＜0.05）.结论非杓型心率有助于早期识别ACS介入治疗术后发生远期不良心脏事件的高危人群. Objective To explore the relationship between non-dipper night rate and prognosis of patients with acute coronary syndrome （ACS） after percutaneous coronary intervention （PCI）.Methods A total of 470 patients with ACS after PCI were divided into non-dipper night rate group（202 cases） and dipper night rate group（268 cases） by results of 24 h dynamic electrocardiogram 4 to 6 weeks after hospital discharge.All patients were treated with antiplatelet drugs and statins after hospital discharge.24 h dynamic electro-cardiograms were recorded for all patients 4 to 6 weeks after hospital discharge.All patients were followed up for more than 12 months.Results Patients in non-dipper night rate group were older and the proportions of old myocardial infarction and multivessel lesion were higher than those in dipper night rate group,while left ventricular ejection fraction measured one day before hospital discharge was lower（P 〈 0.05）.There were no significant differences of other general data between the two groups （P 〉 0.05）.Resting heart rate at admission,mean heart rate in night and high frequency/low frequency in non-dipper heart rate group were higher than those in dipper night rate group,but mean heart rate in day,day-night heart rate dip ratio and standard deviation of normal to normal intervals（SDNN） were lower than those in dipper night rate group （P 〈 0.05）.However,there were no significant differences of resting heart rate after hospital discharge,24 h mean heart rate,rate mean square of the differences of successive RR intervals （RMSSD）,percentage of RR intervals differing 〉 50ms （PNN0） and the follow-up time between the two groups（P 〉 0.05）.Rates of total major adverse cardiac events,cardiac death,nonfatal myocardial infarction,target vessel revascularization and hospitalization readmission in non-dipper heart rate group were significantly higher than those in dipper night rate group during the follow-up period（P 〉0.05）.Conclusion Non-dipper night rate co