心率变异对糖尿病合并冠心病患者的分析

目的 :探讨心率变异 (HRV)对糖尿病特别是合并冠心病患者与自主神经之间的关系。方法 :应用 2 4小时HRV频谱分析技术 ,对单纯 2型糖尿病与合并冠心病患者进行HRV测定 ,并对其时域和频域作相关分析。结果 :糖尿病患者时域与频域分析各项指标均明显降低 ,特别是合并冠心病的各项参数降低更为明显 ,差异有极显著性 ,P <0 0 1。结论 :糖尿病的时域、频域指标均下降与自主神经病变的程度之间具有很高的相关性 ,特别是合并冠心病高频成分明显降低 ,迷走神经兴奋减低 ,可发生恶性心律失常。     

冠状动脉旁路移植术后并发心房颤动的护理

目的　总结冠状动脉旁路移植术 (coronaryarterialbypassgraft ,CABG)后并发心房纤维颤动 (atrialfibrillation ,AF)的临床特征、治疗及护理经验。方法　回顾分析CABG术后 91例并发AF患者的治疗、护理过程及效果。结果　术后并发AF 91例 ,发生率为15 .88% ,AF持续时间 ( 12 .8± 12 .7)h ,患者经药物静脉注射毛花苷C(西地兰 )和 ( /或 )胺碘酮 (可达龙 )治疗后 ,2 4h内恢复窦性心律 83例 ,复律率为 91.2 1%。结论　CABG术后应加强心律、心率的监护 ,及时纠正低血钾、低血镁是预防术后AF发生的有效措施 ,一旦出现AF应及时采取药物治疗 ,确保患者术后顺利康复     

心率变异性在冠心病患者和冠心病合并高血压患者中应用价值的比较

目的探讨心率变异性(HRV)在冠心病和冠心病合并高血压患者中的应用价值。方法选取2014年5月至2014年11月在承德市中心医院行动态心电图(Holter)的检查患者共计105例。冠心病患者53例,冠心病合并高血压患者52例。采用时域分析和频域分析两种分析方法检测HRV,并进行对比分析。结果心率变异性时域分析法中,正常RR间期的标准差指数(SDNNIndex)在冠心病合并高血压组明显低于冠心病组(P0.05);HRV频域分析法中,超低频功率频段(ULF)在冠心病合并高血压组明显低于冠心病组(P0.05),差异均有统计学意义。结论冠心病合并高血压患者比单纯冠心病患者的自主神经损害严重,HRV测定可帮助了解其自主神经的缺失情况,对判断心脏病变程度及改善预后有重要意义。     

心率变异性减低与老年冠心病患者心血管事件的相关性分析

目的：探讨老年冠心病患者心率变异性（HRV）减低与心血管事件的关系。方法：回顾分析我院195例老年冠心病患者24 h动态心电图资料与心血管事件的关系。HRV分析包括时域分析和频域分析。比较查体者有和无心血管事件组各时域和频域参数有无差别。结果：有15例老年冠心病患者发生心血管事件（有心血管事件组）,180例未发生心血管事件（无心血管事件组）,有心血管事件组与无心血管事件组比较,HRV各参数均明显降低（P〈0.01）。结论：一般老年冠心病患者如HRV明显降低,则易于发生心血管事件。     

冠状动脉旁路移植术后早期房颤的护理

目的观察冠状动脉旁路移植术（CABG）后早期心房颤动（AF）的发生率以及相关因素,探讨其预防及护理方法。方法回顾性分析136例首次单纯行CABG病例,并将患者分为AF组和非AF组,对术前和术后资料进行统计分析。结果CABG术后早期48h内AF的发病率为19．8％（27／136）,术前超声心动结果均为左房增大、左室增大及射血分数低。结论AF是CABG术后早期常见的并发症,左房、左室增大及射血分数低的患者,术后早期发生AF的概率高。应对患者术前超声心动进行评估,在术后进行有效的治疗和护理,预防术后早期AF发生。     

心电散点图分析心率变异性的应用价值

目的:探讨心电散点图在心率变异性(heart rate variability,HRV)分析中的作用。方法:将符合条件的104例健康对照者(健康对照组)和185例慢性心力衰竭患者(慢性心力衰竭组)作为研究对象,进行24 h动态心电图检查,采集心电散点图和时域、频域数据,进行统计学分析。结果:健康对照组与慢性心力衰竭组均显示SD1、SD2与时域、频域各项指标均呈现高度正相关。在健康对照组中,80.77%的心电散点图分布图形为棒球拍形,而在慢性心力衰竭组中,95.68%为非棒球拍形。在散点图中,SDNN50 ms者在呈短棒形的病例中占76.67%,在呈不规则形的病例中占70.83%。散点图图形作为独立判断HRV的定性指标,各项数据显示良好。结论:心电散点图图形能够简便、直观显现HRV,联合时域、频域指标,可以进一步提高诊断的特异性。     

肥胖型2型糖尿病患者心率变异性临床分析

目的观察肥胖型2型糖尿病患者和健康体检者心率变异性(heart rate variability,HRV)的差异。方法选取2012年9月—2013年9月我院门诊和住院部收治的肥胖型2型糖尿病50例作为观察组,另选择同期健康体检者60例作为对照组,进行24 h动态心电图监测,收集并比较HRV时域指标和频域指标。结果观察组HRV时域指标和频域指标各参数均显著低于对照组,差异有统计学意义(P0.05或P0.01)。结论肥胖型2型糖尿病患者时域指标和频域指标各参数均较健康体检者降低,提示自主神经功能明显受损。     

综合干预对原发性高血压患者心率变异性的影响

目的：探讨综合干预对原发性高血压患者心率变异性的影响。方法：将100例符合条件的原发性高血压患者随机分为对照组和干预组各50例。对照组实施常规高血压健康宣教;干预组在常规高血压健康宣教的同时进行综合干预措施。然后对两组患者进行心率功率谱时域和频域分析。结果：综合干预明显增加心率变异性（HRV）时域及频域指标（P〈0.05）。结论：综合干预可改善原发性高血压患者的心率变异性。     

高血压合并睡眠呼吸暂停综合征患者血压节律及心率变异的影响研究

目的:研究阻塞性睡眠呼吸暂停综合征(OSAS)对高血压患者血压昼夜节律及心率变异性(HRV)的影响。方法:选取该科诊治的61例患者和30名健康体检人员,根据是否患有高血压及OSAS分为正常对照组、单纯高血压组、高血压合并OSAS组。比较3组之间非杓型昼夜血压曲线的比例、HRV时域指标(低频、高频)与频域指标(SDNN、PNN50)以及夜间平均血氧水平、呼吸紊乱指数(AHI)的差异。结果:高血压合并OSAS组患者呈非杓型昼夜血压曲线的比例以及HRV时域指标(低频、高频)与频域指标(SDNN、PNN50)均较其他两组明显增加(P<0.01);且夜间平均SaO2明显低于其他两组,而AHI则明显高于其他两组(P<0.01)。结论:OSAS合并高血压患者血压昼夜节律呈非杓型,HRV增强,夜间平均血氧水平下降,AHI明显增加,可能是高血压患者心血管事件增加的重要危险因素。     

急诊与限期PCI对急性心肌梗死患者心率变异性及心功能的影响与观察

目的:观察急诊与限期经皮冠状动脉介入治疗(PCI)对急性心肌梗死(AMI)患者心率变异性(HRV)及心功能的影响。方法:选取我院收治的急性ST段抬高型心肌梗死患者66例,分为急诊PCI组和限期PCI组;观察两组患者病后3周和病后6个月的心率变异性及心功能变化情况。结果 :急诊PCI组患者病后3周和病后6个月的HRV时域指标及LVEF之间的差异无统计学意义(P0.05);限期PCI组患者病后6个月的HRV时域指标及LVEF显著高于病后3周(P0.05);急诊PCI组病后3周和病后6个月的HRV时域指标及LVEF均显著高于同时期限期PCI组患者(P0.05)。结论 :急性和限期PCI都可以提高AMI患者的心率变异性和心功能指标,且急诊PCI的改善效果优于限期PCI。     

Electrocardiographic activity before onset of postoperative atrial fibrillation in cardiac surgery patients

Background: Electrocardiographic (ECG) characteristics were analyzed in postoperative cardiac surgery patients in an attempt to predict development of new‐onset postoperative atrial fibrillation (AF). Methods: Nineteen ECG characteristics were analyzed using computer‐based algorithms. The parameters were retrospectively analyzed from ECG signals recorded in postoperative cardiac surgery patients while they were in the cardiovascular intensive care unit (CVICU) at our institution. ECG data from 99 patients (of whom 43 developed postoperative AF) were analyzed. A bootstrap variable selection procedure was applied to select the most important ECG parameters, and a multivariable logistic regression model was developed to classify patients who did and did not develop AF. Results: Premature atrial activity (PAC) was greater in AF patients (P < 0.01). Certain heart rate variability (HRV) and turbulence parameters also differed in patients who did and did not develop AF. In contrast, P‐wave morphology was similar in patients with and without AF. Receiver operating curve (ROC) analysis applied to the model produced a C‐statistic of 0.904. The model thus correctly classified AF patients with more than a 90% sensitivity and a 70% specificity. Conclusion: Among the 19 ECG parameters analyzed, PAC activity, frequency‐domain HRV, and heart rate turbulence parameters were the best discriminators for postoperative AF.     

Autonomic control in patients experiencing atrial fibrillation after cardiac surgery

BACKGROUND: Atrial fibrillation (AF) occurs in 20-40% of patients after open heart surgery and leads to an increased morbidity and prolonged hospital stay. Earlier studies have demonstrated that depressed baroreflex function predicts mortality and major arrhythmic events in patients surviving myocardial infarction. Cardiac surgery per se leads to decreased baroreflex sensitivity (BRS) and heart rate variability (HRV). Hence, the present study was aimed at analyzing the impact of the cardiovascular autonomous system on the development of postsurgical AF. METHODS AND RESULTS: The study covered 51 patients who consecutively underwent aortic valve replacement, coronary artery bypass surgery, or combined procedures. Noninvasive blood pressure and ECG were recorded the day before and 24 hour after surgery. BRS, linear as well as nonlinear HRV parameters were calculated using established methods. Eighteen patients developed AF during the first postoperative week, while 33 remained in sinus rhythm (SR) throughout the observation period. Patients with postoperative (PostOp) AF exhibited a significantly reduced preoperative (PreOp) BRS in terms of bradycardic and tachycardic regulation (average delayed slope [ms/mmHg]: SR: PreOp: 9.83 +/- 3.26, PostOp: 6.02 +/- 2.29, Pre-Post: P < 0.001; AF: PreOp: 7.59 +/- 1.99, PostOp: 6.39 +/- 3.67, Pre-Post: P < 0.044; AF vs SR: PreOp: P < 0.01, PostOp: ns). In both groups, surgery caused a decrease of BRS and HRV. Analysis of nonlinear dynamics revealed a tendency toward decreased system complexity caused by the operation; this trend was significant in patients remaining in sinus rhythm. CONCLUSIONS: Patients experiencing postoperative AF obviously suffer from an impaired BRS before surgery already. These findings may be used to guide prophylactic antiarrhythmic therapy.     

Temporary Atrial Pacing in the Prevention of Postoperative Atrial Fibrillation

Background: Atrial fibrillation (AF) is a common complication after coronary artery bypass grafting (CABG). Since its prevention with prophylactic drug therapy has limited success, alternative approaches are desirable. This study examined the efficacy of atrial or biatrial pacing, compared with no pacing, on the incidence of AF after isolated CABG.
Methods: From August 2002 to September 2004, 240 patients underwent CABG. After surgery, right and left atrial epicardial pacing wires were implanted for 72 hours of temporary pacing. Patients were randomly assigned to one of three groups: no pacing (control group), right atrial (RA), and biatrial (BiA) pacing. Cardiac rhythm was monitored continuously during intensive care, or daily on the ward. The primary endpoints of this study were an episode of AF occurring up to 72 hours after CABG and the risk factors correlated with this event.
Results: Atrial and BiA pacing significantly lowered the incidence (1.25% vs 25%, P = 0.001) of AF episodes, and were both correlated (odd ratio 0.038; 95% confidence interval 0.005–0.29) with a decrease in rates of postoperative AF. Multivariable analysis identified older age (odd ratio 1.074; 95% confidence interval 1.024–1.12) and no pacing as independent risk factors of postoperative AF.
Conclusions: Temporary right atrial or biatrial pacing after CABG significantly decreased the postoperative incidence of AF. Multivariable analysis identified older age and no pacing as predictors of AF occurrence .     

Heart rate variability response to standing in men and women receiving d,l-sotalol following coronary artery bypass graft surgery

Heart rate variability (HRV), a quantitative marker of autonomic control of heart rate (HR), declines in men and women following coronary artery bypass graft (CABG) surgery. Although d,l-sotalol is prescribed following CABG surgery primarily for its antiarrhythmic effect, its effects on HRV have not been reported; the β-adrenergic antagonist effect of d,l-sotalol may attenuate sympathetically mediated HR and blood pressure (BP) responses to standing, resulting in postural hypotension. In this study, the HRV response to standing 4 days following CABG surgery in men and women prescribed d,l-sotalol was measured to examine the influence of d,l-sotalol on previously reported HRV responses, taking age and gender into consideration. Participants included 28 men and 10 women who completed testing in supine and standing postures; all had received low-dose d,l-sotalol daily since the first postoperative day. Data included continuous electrocardiograph recording of R-R interval for 10 min in each posture. Participants showed significant effects of standing on the autonomic modulation of HR, as seen by a decrease in parasympathetic indices and R-R interval and an increase in BP. In men, standing decreased parasympathetic modulation and increased the sympathetic nervous system indicator, but previously reported age effects were not seen. In women, standing decreased low frequency power and R-R interval and increased BP, with older women having a smaller increase in BP, suggesting an attenuated response. The differential autonomic nervous system modulation of HR as a function of gender and age after CABG surgery may be attenuated by d,l-sotalol.     

Autonomic Denervation After the Maze Procedure

LÖNNERHOLM, S., et al .: Autonomic Denervation After the Maze Procedure. The Maze III procedure is a surgical operation for curative treatment of AF. The procedure is extensive, however, with multiple incisions in both atria, and its effects on autonomic regulation of the heart rhythm are not known. This study comprises 17 patients, 10 with paroxysmal AF and 7 with chronic AF, who had no concurrent cardiac disease known to affect heart rate variability (HRV). A 24-hour Holter recording was performed preoperatively and 2 months (early) and 7 months (late) after surgery, for analysis of HRV in the time and frequency domains. Early after the Maze procedure all HRV components were markedly reduced compared to baseline (mean ± 1 SD): SDNN   73 ± 13   versus   148 ± 50   (ms), total power   168 ± 126   versus   560 ± 1567   (ms²), low frequency (LF) power   47 ± 67   versus   826 ± 677   (ms²), high frequency (HF) power   47 ± 40   versus   678 ± 666   (ms²), and LF:HF   1.22 ± 0.9   versus   2.55 ± 1.4   . Late after the Maze procedure all variables were still reduced. Only total power increased significantly between early and late follow-up (   168 ± 126   vs   496 ± 435   ms²). Late after Maze surgery, values of the different HRV components did not differ between the patients with paroxysmal AF and chronic AF. Early after the Maze procedure there is a marked decrease of all HRV components, which is maintained 7 months after surgery, a pattern consistent with denervation of the heart. (PACE 2003; 26[Pt. I]:587–592)     

Clinical outcome of patients who develop PAF after CABG surgery

This was a retrospective analysis of patients who had CABG surgery at our hospital over a 12-month period to determine the intermediate-term prognosis of those who had developed PAF after their operation before hospital discharge. Of 317 patients who were operated by a single surgical group, 116 (37%) had AF postoperatively of whom 112 had the paroxysmal form. Of these, 36 were treated with class I or III antiarrhythmic drugs and rate control drugs (group 1) and 76 were treated with rate control alone (group 2). Group 3 consisted of 151 randomly selected patients who did not have AF. All patients were reevaluated at 6 weeks to determine their rhythm and clinical status. Only one patient each in groups 1 and 2 was in AF 6 weeks after discharge. There was a trend toward a higher mortality and morbidity in group 2 patients. PAF after coronary surgery appears to be a self-limited disease process. In this cohort of patients, the rate of recurrence of AF after discharge was similar in patients receiving class I or class III antiarrhythmic drugs together with rate control agents compared to those receiving rate control drugs alone.     

The role of angina pectoris in chronic pain after coronary artery bypass graft surgery.

Visceral nociception readily sensitizes the central nervous system, causing referred somatic pain and hyperalgesia via somato-visceral convergence. Hyperalgesia in the perioperative period may increase vulnerability to subsequent development of chronic pain. The study aim is to investigate the role of angina pectoris, an ischemic visceral pain, in long-term pain after coronary artery bypass surgery (CABG). We sent questionnaires to 369 patients who underwent CABG surgery in 2003. Questions were asked about angina pectoris and other pain in the period before surgery, the first week postoperatively (= acute pain), and the period after 3 months after surgery (= chronic pain). We obtained results from 256 patients (response rate = 69%). The point prevalence of chronic pain after CABG was 27% after a mean follow-up of 16 months (SD +/- 3 months). Patients with chronic pain after CABG had more angina pectoris than those without chronic pain: Before surgery (P = .07), early on postoperatively (P = .004), and more than 3 months after surgery (P = .000004). We found cumulative prevalences of chronic pain after CABG at 3 months of 39%, and of 32% after 6 months. Other predictive factors for chronic pain after CABG were acute postoperative pain (P = .00002) and younger age (P = .002). Angina pectoris is associated with chronic pain after CABG surgery. Other predictive factors include acute postoperative pain and younger age. PERSPECTIVE: The influence of postoperative angina pectoris for chronic pain after CABG surgery has not been described in the literature to date. Visceral nociception may play an important role in the development of chronic pain after surgery and should be taken into account in future studies.     

Amiodaron in atrial fibrillation: post coronary artery bypass graft

BACKGROUND: Atrial fibrilation (AF) is the most common complication following heart surgeries; it often occurs in patients after coronary artery bypass graft (CABG). The purpose of this review is to categorize prophylaxes or treatment by administration of Amiodaron in patients with CABG.DATA RESOURCES: We searched google scholar, pubmed, and Cochrane Library databases (the period 1970-2010) for articles on Amiodaron in CABG and cardiac surgery. A total of 1 561 articles were identified, and 30 articles met the criteria and were enrolled in this review.RESULTS: Most studies supported Amiodarone for prophylaxi purpose in patients who were performed with CABG; few papers supported Amiodaron as a drug for treating CABG. The prophylaxis can decrease the incidence rate of AF in CABG, but if it uses as a treatment, the side effect of Amiodaron will decrease because all of the patients will not get Amiodarone. In the other hand use of Amiodarone as a treatment does not influence the length of hospital stay significantly but these kinds of study are so few.CONCLUSION: No appropriate therapeutic method has been defined for AF. At present, the common way of treating AF following cardiac surgery is mainly based on prophylaxis in medical books and references.     

Heart rate variability following neonatal heart surgery for complex congenital heart disease

BACKGROUND: Altered cardiac autonomic control may play a role in the morbidity and mortality suffered by neonates who undergo surgery for complex congenital heart disease (CHD). The purpose of this study was to evaluate cardiac autonomic activity, as measured by spectral indices of heart rate variability (HRV), prior to and early after infant surgery for CHD and attempt to correlate HRV indices with clinical outcome. In addition, we assessed the hypothesis that single-ventricle physiology and surgical interruption of the great arteries negatively affects HRV. METHODS: Sixty neonates prospectively wore 24-hour Holter monitors at three time points: before and early after CHD surgery, and at 3- to 6-month follow-up. Standard spectral indices of HRV were measured. RESULTS: In the early postoperative time point, patients with single-ventricle physiology had lower low-frequency power (LF) compared to patients with two ventricles (P=0.040). Surgical interruption of the great arteries did not affect HRV in this cohort. For the entire cohort, LF (P=0.004) and high-frequency power (HF) (P<0.001) increased over the three time points, while LF/HF (P=0.119) did not significantly change. In the multivariable linear regression model, significant predictors of longer postoperative hospital stay included longer total support time (P=or<0.001), longer duration of inotrope support (P=0.012), elevated mean heart rate at postoperative time point (P=0.002), and lower LF/HF ratio at the postoperative time point (P=0.014). CONCLUSION: Patients with single-ventricle physiology have a significant physiologic reduction in LF in the early postoperative period compared to patients with two ventricles. Diminished cardiac autonomic control is associated with longer hospitalization following neonatal cardiac surgery.     

Evaluation of coated oxygenators in cardiopulmonary-bypass systems and their impact on neurocognitive function

INTRODUCTION: Coronary artery bypass graft surgery (CABG) using cardiopulmonary bypass (CPB) is assumed to be associated with a decline of neurocognitive functions. This study was designed to analyse the neurocognitive function of patients with coronary heart disease before and after CABG and to determine possible protective effects of oxygenator surface coating on neurological outcome. METHODS: Forty patients scheduled for selective CABG were prospectively randomized into two groups of 20 patients each according to the type of hollow-fibre membrane oxygenator used. Non-coated oxygenators (Group A) were compared to phosphorylcholine (PC)coated oxygenators (Group B). A battery of six neurological tests was administered preoperatively, 7-10 days and 4-6 months after surgery. RESULTS: One patient of Group A suffered from a perioperative stroke and died on postoperative day 3, presumably because of sudden heart failure. Two patients of Group A (10%) developed a symptomatic transitory delirious psychotic syndrome (STPT) on postoperative days 3 and 5. None of the patients of Group B had perioperative complications. The test analysis revealed a trend of declined neurocognitive function early after CABG, but did not show any difference in neurocognitive outcome between the two groups. DISCUSSION: PC coating of the oxygenators did not show any significant benefit on neurocognitive function after CABG using CPB.