心律變異是否可爲冠狀動脈手術的預後因子

在冠狀動脈疾病患者及心肌梗塞後的病患，學者發現自主神經心臟及血管功能的失調會導致心室心律不整及突然死亡的風險。文獻回顧也顯示心律變異反映出左心室失能的狀況及心肌梗塞後的死亡率。本研究主旨在利用術前心律變異的測量，評估該數值對於冠狀動脈繞道手術後的病患是否具有臨床上的意義，以及是否能作爲有效的預防因子。共有25人參與此研究計畫，其中有4人在術後死亡。病患接受心律變異分析監測儀收集術前資料，將資料儲存於SD記憶卡後再擷取至個人電腦進行分析。本試驗採用線性分析的頻率領域法(frequency dominant)及非線性分析法(Poincare plot analysis)，將參與對象分爲死亡組及存活組，進行二維度重複測量變異數分析(2 way ANOVA with repeated measure)，結果兩組之比較均無統計上的意義。以心律變異作爲冠狀動脈繞道手術的預後因子在本研究證據雖不明確，但從文獻回顧，非侵犯性的心律變異的評估可作爲許多預估併發症的因子，因此完整的冠狀動脈繞道手術之術後照顧應將持續心律變異的測量視爲不可或缺的工具，以提升醫療品質。

關鍵字

心律變異；冠狀動脈繞道手術；預後因子

並列摘要

Imbalance in automatic cardiovascular function has been shown to increase the risk of ventricular arrhythmias and sudden death in patients with coronary artery disease and after myocardial infarction. The study evaluated preoperative heart rate variability (HRV) as an independent prognostic factor for hospitalized patients undergoing coronary artery bypass surgery (CABG).In this single-blind study, we enrolled 25 patients scheduled to undergo CABG. Preoperative Holter electrocardiography was used to collect linear analysis and non-linear analysis (Poincare plot analysis) data. Four patients died after the operation. We compared the HRV data of the 2 groups (expired vs. survived), and found that the data showed no statistical significance. Therefore, HRV can not be used as a prognostic factor for post-operative survival or mortality in our study with small sample size and older age.We concluded that HRV cannot be used as a prognostic factor after CABG surgery, however, continuous HRV analysis during postoperative hospitalization can predict some major cardiac events and complications.

並列關鍵字

heart rate variability ； coronary artery bypass surgery ； prognostic factor

國際替代計量

心律變異是否可爲冠狀動脈手術的預後因子

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