脑卒中患者心率变异性特征研究
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摘要
目的观察脑卒中与非脑卒中患者的心率变异性(heart rate variability,HRV),探讨脑卒中对HRV的影响。方法选择2012年7月—2013年9月收治的72例脑卒中作为观察组,选择同期住院的非脑血管疾病患者80例作为对照组。对两组进行24 h的HRV监测,于入院后24 h和治疗1个月后分别进行监测,观察两组HRV的变化情况。结果观察组在入院后24 h和治疗1个月后全程全部窦性R-R间期的标准差(SDNN)、24 h内每5分钟时段窦性R-R间期平均值的标准差(SDANN)、全程全部窦性R-R间期的平方根(r MSSD)、两个相邻R-R间期互差>50 ms的心跳次数所占分析信息间期内心搏数的百分比(PNN50)、总功率谱(TP)、低频功率谱(LF)、高频功率谱(HF)较对照组降低,LF/HF较对照组增高(P<0.05);观察组治疗1个月后SDNN、SDANN、r MSSD、PNN50、TP、LF、HF较入院后24 h升高,LF/HF较入院24 h降低(P<0.05)。观察组入院24 h日间和夜间HRV比较差异无统计学意义(P>0.05);观察组治疗1个月和对照组夜间HRV均高于日间(P<0.05);观察组治疗1个月后日间和夜间SDNN、SDANN、r MSSD、PNN50、夜间LF、夜间HF并较入院24h时均显著升高,LF/HF、TP、日间LF、日间HF较入院24 h时降低(P<0.05)。结论脑卒中患者HRV昼夜间波动节律减弱或消失,植物神经功能受损严重,随着治疗时间的延长,迷走和交感神经间逐渐平衡调控,HRV节律逐步恢复。
Objective To observe the heart rate variability( HRV) of cerebral apoplexy and non cerebral apoplexy patients so as to investigate the effects of cerebral apoplexy on HRV. Methods A total of 72 cerebral apoplexy patients admitted during July 2012 and September 2013 were selected as the observation group,and 80 non cerebral apoplexy patients admitted at the same period were chosen as control group. The 24 h HRV monitoring tests were performed in the two groups at 24 h after admission and in treatment for 1 month respectively,and HRV changes in the two groups were observed. Results In observation group,the values of standard deviation of RR intervals( SDNN) at 24 h after admission and in treatment for 1 month,standard deviation of average RR intervals for each 5 min period of the 24 h( SDANN),root mean standard deviation of successive RR( r MSSD),percentage of successive RR interval deviation greater than 50 ms( PNN50),total power spectrum( TP),low frequency power density( LF) and high frequency power density( HF) were lower than those in the control group,while the LF/HF value was higher than that in control group( P < 0. 05). In observation group,the values of SDNN,SDANN,r MSSD,PNN50,TP,LF and HF were higher,while the LF/HF value was lower in treatment for 1 month than those at 24 h after the admission( P < 0. 05); at 24 h after the admission,there were no significant differences in the values of HRV at day and night( P > 0. 05). In the two groups after treatment for 1 month,the values of HRV at night were higher than those at day time in those at day time in the same group( P < 0. 05); after treatment for 1 month the values of SDNN,SDANN,r MSSD and PNN50 at day time and night,and LF and HF at night were significantly increased,while the values of LF/HF,TP,daytime LF and HF were decreased compared with those at 24 h after the admission( P < 0. 05). Conclusion The weakened or disappeared HRV circadian rhythm fluctuation and badly damaged autonomic nerve function can be found in cerebral apoplexy patients,and the vagal and sympathetic nerves may gradually become balance regulation,and HRV rhythm may gradually recover with the course of treatment.
Objective To observe the heart rate variability( HRV) of cerebral apoplexy and non cerebral apoplexy patients so as to investigate the effects of cerebral apoplexy on HRV. Methods A total of 72 cerebral apoplexy patients admitted during July 2012 and September 2013 were selected as the observation group,and 80 non cerebral apoplexy patients admitted at the same period were chosen as control group. The 24 h HRV monitoring tests were performed in the two groups at 24 h after admission and in treatment for 1 month respectively,and HRV changes in the two groups were observed. Results In observation group,the values of standard deviation of RR intervals( SDNN) at 24 h after admission and in treatment for 1 month,standard deviation of average RR intervals for each 5 min period of the 24 h( SDANN),root mean standard deviation of successive RR( r MSSD),percentage of successive RR interval deviation greater than 50 ms( PNN50),total power spectrum( TP),low frequency power density( LF) and high frequency power density( HF) were lower than those in the control group,while the LF/HF value was higher than that in control group( P < 0. 05). In observation group,the values of SDNN,SDANN,r MSSD,PNN50,TP,LF and HF were higher,while the LF/HF value was lower in treatment for 1 month than those at 24 h after the admission( P < 0. 05); at 24 h after the admission,there were no significant differences in the values of HRV at day and night( P > 0. 05). In the two groups after treatment for 1 month,the values of HRV at night were higher than those at day time in those at day time in the same group( P < 0. 05); after treatment for 1 month the values of SDNN,SDANN,r MSSD and PNN50 at day time and night,and LF and HF at night were significantly increased,while the values of LF/HF,TP,daytime LF and HF were decreased compared with those at 24 h after the admission( P < 0. 05). Conclusion The weakened or disappeared HRV circadian rhythm fluctuation and badly damaged autonomic nerve function can be found in cerebral apoplexy patients,and the vagal and sympathetic nerves may gradually become balance regulation,and HRV rhythm may gradually recover with the course of treatment.
引文
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[11]盛静宇,孙建辉,石红建,等.心率减速力预警高危肥厚型心肌病患者的临床价值[J].江苏实用心电学杂志,2013,22(6):841-843,846.
[12]张丽华,张夏琳,郄淑燕,等.放松训练对脑卒中后抑郁患者心率变异性的影响[J].中国康复,2014,29(1):15-17.
[13]许先继,陈国庆,林艳足.心血管高反应对男性高血压患者血压昼夜节律及心率变异的影响[J].广东医学,2013,34(14):2234-2235.
[14]周建华,程昌霞,王斌,等.高血压合并冠心病患者心率减速力与心率变异性的相关性[J].心血管康复医学杂志,2014,23(2):152-154.
[15]白梅,李学文,彭瑞华,等.心率减速力与心率昼夜节律对高血压患者预后的影响[J].中华临床医师杂志:电子版,2013,7(22):9894-9897.
[16]王韵喃,卢华安,陈杰.脑卒中患者睡眠结构与心率变异性的相关性研究[J].现代中西医结合杂志,2014,23(5):478-480.
[17]林升,罗海龙.脑梗死后心率变异的常见临床因素分析[J].中华神经医学杂志,2010,9(2):176-180.
[18]武燕,李敏,蔺洪翔,等.缺血性脑卒中抗血小板治疗的研究进展[J].中国全科医学,2015,18(23):2865-2869.
[19]强望远,马红京,袁顺英,等.中年急性心肌梗死后恶性室性心律失常与心率变异性及QT间期变异度异常的相关性[J].中国组织工程研究,2015,19(S5):68-69.
[20]贾志越,关欣,王国凤,等.血压变异性与心率变异性的相关性分析[J].中国药物与临床,2015,15(5):683-685.
[21]杨曼华,陈妍,林羽.急性脑卒中患者泌尿系感染危险因素分析[J].福建医药杂志,2015,37(3):56-57.
[22]宋冬红.中西医结合治疗急性脑出血的临床观察[J].湖北中医杂志,2015,37(2):39.
[23]胡祥国.脑心通胶囊联合丹红注射液治疗老年冠心病心力衰竭的临床观察[J].中西医结合研究,2015,7(3):134-135.
[2]段班燕,党书毅,周明,等.不同剂量卡维地洛对急性心肌梗死患者QT离散度、JT离散度及心率变异性的影响[J].疑难病杂志,2014(1):15-17.
[3]苏健.急性心肌梗死患者心率变异性的分析及临床意义[J].中国医药指南,2014,12(16):236-237.
[4]王征,韩飞舟,杨建涛,等.心血管高反应对男性高血压患者血压昼夜节律及心率变异的影响[J].中华老年多器官疾病杂志,2012,11(6):427-430.
[5]Brion R.Sport-related sudden death and its prevention[J].Bull Acad Natl Med,2010,194(7):1237-1245.
[6]吴志忍,林荣,吴兵.心率减速力与连续心率减速力对急性心肌梗死患者预后的影响[J].解放军医学院学报,2013,34(12):1242-1245.
[7]陈舒玲,翁智远,李贵,等.特发性右室流出道室早患者心率减速力与心率变异性分析[J].泰山医学院学报,2013,34(11):801-804.
[8]Taylor A J,Al-Saadi N,Abdel-Aty H,et al.Elective percutaneous coronary intervention immediately impairs resting microvascular perfusion assessed by cardiac magnetic resonance imaging[J].Am Heart J,2006,151(4):891.
[9]郭宝玉,李建红.血压昼夜节律与心率变异对脑卒中患者的影响[J].临床医药实践,2014,23(3):200-204.
[10]刘小英,侯玉立,彭瑞华,等.心率减速力及心率变异对脑卒中患者的临床意义[J].中国药物与临床,2014,14(4):516-517.
[11]盛静宇,孙建辉,石红建,等.心率减速力预警高危肥厚型心肌病患者的临床价值[J].江苏实用心电学杂志,2013,22(6):841-843,846.
[12]张丽华,张夏琳,郄淑燕,等.放松训练对脑卒中后抑郁患者心率变异性的影响[J].中国康复,2014,29(1):15-17.
[13]许先继,陈国庆,林艳足.心血管高反应对男性高血压患者血压昼夜节律及心率变异的影响[J].广东医学,2013,34(14):2234-2235.
[14]周建华,程昌霞,王斌,等.高血压合并冠心病患者心率减速力与心率变异性的相关性[J].心血管康复医学杂志,2014,23(2):152-154.
[15]白梅,李学文,彭瑞华,等.心率减速力与心率昼夜节律对高血压患者预后的影响[J].中华临床医师杂志:电子版,2013,7(22):9894-9897.
[16]王韵喃,卢华安,陈杰.脑卒中患者睡眠结构与心率变异性的相关性研究[J].现代中西医结合杂志,2014,23(5):478-480.
[17]林升,罗海龙.脑梗死后心率变异的常见临床因素分析[J].中华神经医学杂志,2010,9(2):176-180.
[18]武燕,李敏,蔺洪翔,等.缺血性脑卒中抗血小板治疗的研究进展[J].中国全科医学,2015,18(23):2865-2869.
[19]强望远,马红京,袁顺英,等.中年急性心肌梗死后恶性室性心律失常与心率变异性及QT间期变异度异常的相关性[J].中国组织工程研究,2015,19(S5):68-69.
[20]贾志越,关欣,王国凤,等.血压变异性与心率变异性的相关性分析[J].中国药物与临床,2015,15(5):683-685.
[21]杨曼华,陈妍,林羽.急性脑卒中患者泌尿系感染危险因素分析[J].福建医药杂志,2015,37(3):56-57.
[22]宋冬红.中西医结合治疗急性脑出血的临床观察[J].湖北中医杂志,2015,37(2):39.
[23]胡祥国.脑心通胶囊联合丹红注射液治疗老年冠心病心力衰竭的临床观察[J].中西医结合研究,2015,7(3):134-135.