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題 名 | The Effect of Thrombolytic Therapy on Short-And Long-Term Cardiac Autonomic Activity in Patients with Acute Myocardial Infarction=急性心肌梗塞後血栓溶解劑治療對於短期及長期心臟自律神經活性之影響 |
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作 者 | 陳政康; 劉炎明; 李文領; 劉尊睿; 鄭鴻璋; 楊代雲; 胡為雄; 丁紀臺; | 書刊名 | 中華醫學雜誌 |
卷 期 | 58:6 1996.12[民85.12] |
頁 次 | 頁392-399 |
分類號 | 415.3161 |
關鍵詞 | 急性心肌梗塞; 心臟自律神經活性; 心率變異度; 血栓溶解治療; Acute myocardial infarction; Cardiac autonomic activity; Heart rate variability; Thrombolytic therapy; |
語 文 | 英文(English) |
中文摘要 | 背景 急性心肌梗塞後,心率變異度降低,是造成死亡及致命心律不 整的重要危險因子。近幾年來,血栓溶解劑可以改善急性心肌梗塞之治療,然 而對其改善心臟血管死亡率之機轉只有少數資料。本研究之目的即在探討急性 心肌梗塞後,血栓溶解治療和心臟自律神經活性,以及心率變異度的連續變化 之間的關係。 方法 自1994年10月到1995年7月,所有首次急性心肌梗塞患者皆進入此 一研究。患者在症狀發生六小時內符合標準者,接受血栓溶解治療。其他患者 接受保守治療。所有患者在心肌梗塞後7,90,180天均接受24小時心電圖監 測,分析時間領域及頻律領域心率變異度。 結果 本研究共包含49位患者,45位男性,4位女性,年齡由41歲到78歲。 短期 (7天) 心率變異度在接受血栓溶解治療組與未接受組比,其SDANN及 SDNN有明顯增加之情形,但是在rMSSD,pNN50,HF,LF,LF/HF則無差異。 梗塞部位並不影響短期心率變異度。接受血栓溶解治療者,其90天及180天的 心率變異度,與7天者比較,在SDANN及SDNN,LF,HF上有明顯增加。而 未接受血栓溶解治療者,其90天及180天的心率變異度與7天者比較只有SDANN 及SDNN有明顯增加,在修正心室射出分率後,接受血栓溶解治療者其短期心 率變異度在SDANN及SDNN上,仍舊高於未接受血栓溶解治療者。而90天和 180天的心率變異度,接受血栓溶解與未接受血栓溶解治療者則無差異。在追 蹤過程中有3位患者發生瘁死,其心率變異度遠低於存活者。 結論 本研究主要有兩點發現:1) 無併發症之急性心肌梗塞患者,無論是否 接受血栓溶解劑治療,其心率變異度皆有暫時降低,且在三個月內有改善之情 形,2) 接受血栓溶解治療比未接受血栓溶解治療之急性心肌梗塞患者其短期 (7 天) 心率變異度有較明顯的改善,此一改善和心室射出分率之間並無相關,此 應為血栓溶解劑治療急性心肌梗塞之另一益處。 |
英文摘要 | Background. Reduced heart rate variability after acute myocardial infarction is an important risk stratification factor for mortality and life threatening ventricular arrhythmias. In recent years, thrombolytic therapy has revolutionized the therapy of acute myocardial infarction. However, there is little information about the mechanism of the beneficial effect of thrombolysis on cardiovascular mortality. This study was launched to investigate the relationship between thrombolytic therapy and cardiac autonomic activity, and the sequential changes in heart rate variability after acute myocardial infarction. Methods. From October 1994 to July 1995, all consecutive patients with their first acute myocardial infarction were prospectively enrolled into the study. Patients without contraindication underwent thrombolytic therapy within six hours of the onset of symptoms. Other patients received conventional treatment. Ambulatory electrocardiography (EKG) was recorded on each patient 7, 90 and 180 days after acute myocardial infarction. Heart rate variability in time- and frequency-domain was analyzed. Results. A total of 49 patients, 45 males and 4 females, were included in this study. The short-term heart rate variability (HRV) (seven-day) in the thrombolytic group was significantly higher than in the nonthrombolytic group in SDANN and SDNN. No significant difference in rMSSD, pNN50, LF, HF or LF/HF ratio was found. The location of MI did not influence the short-term HRV following acute myocardial infarction. In patients treated with thrombolytic agent, the follow-up HRV at 90 days and 180 days increased significantly compared to the baseline HRV (seven-day) in SDANN, SDNN, LF and HF bands. For patients without thrombolytic therapy, their follow-up HRV at 90-day and 180-day increased significantly as compared to the baseline HRV (seven-day) in SDANN and SDNN only. After correction of ventricular ejection fraction, the higher short-term (seven day) HRV activities were still present in SDANN and SDNN in patients with thrombolysis as compared to those without. The 90-day and 180-day HRV did not differ between patients with and without thrombolytic agent. Three patients died suddenly during follow-up, and all showed significantly lower values of HRV than the survivors. Conclusions. The findings of the present study suggest that 1) in patients with uncomplicated AMI, HRV was transiently reduced with progressive improvement within three months after AMI in both those with and without thrombolytic therapy. and 2) patients who had received thrombolytic treatment had more improved HRV early (seven days) after AMI than those who did not. This improvement, independent of the change of left ventricular function, could be HRV and Thrombolytic Therapy in AMI associated with the beneficial effect of thrombolytic therapy in patients with AMI. |
本系統中英文摘要資訊取自各篇刊載內容。