标题：胺碘酮对STEMI合并持续性室颤患者心率变异性及预后的影响

      作者：刘娟，乔庆涛    北京中医药大学孙思邈医院心血管内科，陕西 铜川 727100

      卷次： 2021年32卷2期

      【摘要】 目的 探讨胺碘酮对ST段抬高型心肌梗死(STEMI)合并持续性室颤患者心率变异性及预后的影响，为临床治疗提供依据。方法 选取北京中医药大学孙思邈医院2018年1月至2019年10月收治的70例STEMI合并持续性室颤住院患者为研究对象，按照随机数表法将患者分为观察组和对照组，每组35例。在基础治疗的基础上，对照组患者给予利多卡因治疗，观察组患者给予胺碘酮治疗，两组患者均持续治疗7 d。分别于治疗前、治疗7 d后比较两组患者心率变异性指标中24 h相邻RR间期差值的均方根(RMSSD)、24 h每5 min正常RR间期平均值的标准差(SDANN)、24 h正常RR间期标准差(SDNN)，心功能左心室射血分数(LVEF)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)，并比较治疗7 d后两组患者不良反应发生率，于治疗前、治疗后1个月、3个月通过门诊随访比较两组患者心肌梗死溶栓试验(TIMI)危险评分变化情况。结果 观察组患者治疗7 d后的RMSSD为(37.34±5.76) ms、SDANN为(90.49±7.73) ms、SDNN为(103.38±9.27) ms，明显高于对照组的(30.17±4.38) ms、(72.61±6.69) ms、(90.27±8.29) ms，差异均有统计学意义(P<0.05)；观察组治疗7 d后的LVEDD、LVESD分别为(54.12±2.42) mm、(42.12±2.58) mm，明显低于对照组的(56.64±4.63) mm、(45.61±3.61) mm，LVEF为(56.54±6.38)%，明显高于对照组的(51.27±5.13)%，差异均有统计学意义(P<0.05)；治疗后 1个月、3个月，观察组患者的TIMI危险评分分别为(4.28±1.16)分、(1.36±0.24)分，明显低于对照组的(5.77±1.53)分、(2.51±0.53)分，差异均有统计学意义(P<0.05)；观察组患者的不良反应发生率为8.56%，明显低于对照组的28.57%，差异有统计意义(P<0.05)。结论 胺碘酮治疗STEMI合并持续性室颤可促进患者心功能及心率变异性的改善，降低TIMI危险评分，安全性高，值得临床推广应用。
      【关键词】 ST段抬高型心肌梗死；持续性室颤；胺碘酮；利多卡因；心率变异性
      【中图分类号】 R541.7 【文献标识码】 A 【文章编号】 1003—6350（2021）02—0169—04

Effects of amiodarone on heart rate variability and prognosis in patients with ST segment elevation myocardialinfarction and persistent ventricular fibrillation.
LIU Juan, QIAO Qing-tao. Department of Cardiovascular Medicine,the Sun Simiao Hospital of Beijing University of Chinese Medicine, Tongchuan 727100, Shaanxi, CHINA
【Abstract】 Objective To explore the effect of amiodarone on heart rate variability and prognosis in patientswith ST segment elevation myocardial infarction (STEMI) and persistent ventricular fibrillation, so as to provide basisfor clinical treatment. Methods Seventy hospitalized patients with STEMI complicated with persistent ventricular fi-brillation admitted to Sun Simiao Hospital of Beijing University of Traditional Chinese Medicine from January 2018 toOctober 2019 were selected as the research objects. According to the random number table, the patients were divided in-to observation group and control group, with 35 patients in each group. On the basis of basic treatment, the control groupwas given lidocaine treatment, and the observation group was given amiodarone treatment, both for 7 days. The rootmean square of the difference between the 24 h adjacent RR intervals (RMSSD), the standard deviation of the averagevalue of the normal RR interval every 5 minutes (SDANN), and the standard deviation (SDANN) of the heart rate vari-ability indexes of the two groups were compared before treatment and 7 days after treatment. 24 h normal RR intervalstandard deviation (SDNN), cardiac function left ventricular ejection fraction (LVEF), left ventricular end diastolic diam-eter (LVEDD), left ventricular end systolic diameter (LVESD), and the adverse reactions after 7 days of treatment werecompared between the two groups. The myocardial infarction thrombolytic test (TIMI) risk score before treatment, 1month after treatment, and 3 months after treatment were compared between the two groups. Results After 7 days oftreatment, the RMSSD of the observation group was (37.34±5.76) ms, SDANN was (90.49±7.73) ms, and SDNN was(103.38±9.27) ms, which were significantly higher than (30.17±4.38) ms, (72.61±6.69) ms, (90.27±8.29) ms of the con-trol group (P<0.05); the LVEDD and LVESD of the observation group after 7 days of treatment were (54.12±2.42) mmand (42.12±2.58) mm, respectively, which were significantly lower than (56.64±4.63) mm and (45.61±3.61) mm of thecontrol group; the LVEF was (56.54± 6.38)%, significantly higher than (51.27±5.13)% in the control group; the differ-ences were statistically significant (P<0.05). One month after treatment and 3 months after treatment, the TIMI riskscores of the observation group were (4.28±1.16) points and (1.36±0.24) points, which were significantly lower than(5.77±1.53) points and (2.51±0.53) points of the control group (P<0.05). The incidence of adverse reactions in the obser-vation group was 8.56%, which was significantly lower t