心血管病患者与健康成人心率变异性的比较

目的比较心血管疾病与健康成人的心率变异性。方法应用12通道动态心电图对273例心血管病患者(实验组)与210例健康成人(对照组)的HRV时域和频域指标进行对比分析。HRV时域指标:24h全部窦性RR间期的标准差(SDNN)、24h连续5min窦性RR间期均值标准差(SDANN)、相邻RR间期差值均方根(rMSSD)、相邻窦性RR间期差值大于50ms的百分比(PNN50);HRV频域指标:总功率(TP)、极低频功率(VLF)、低频功率(LF)、高频功率(HF)及LF/HF。结果心血管病患者的年龄、SDNN、SDANN、rMSSD、TP及VLF较对照组差异有统计学意义(p<0.05),而PNN50、LF、HF及LF/HF差异无统计学意义(p>0.05)。结论心血管病患者心脏自主神经调控功能紊乱,迷走神经活性降低,交感神经活性增强。     

肾衰患者血液透析前后HRV变化及意义

目的探讨终末期肾衰患者血液透析前后心率变异性(HRV)的变化及意义。方法对267例终末期慢性肾衰规律血液透析患者和60例健康人行24小时动态心电图检查,分析两组血液透析前后终末期肾衰患者的HRV改变。HRV时域指标包括正常RR间期标准差(SDNN),5min平均RR间期标准差(SDANN)等。结果正常健康组的HRV有明显的昼夜变化规律,HRV夜间大于白天;终末期肾衰患者的HRV明显低于健康组,其昼夜节律性消失,但透析后HRV指标明显改善。结论终末期肾衰患者的HRV与健康人相比有显著的变化,其迷走神经张力减退和HRV昼夜节律性消失。血液透析可提高终末期肾衰患者HRV并改善肾衰患者受损的植物神经功能。     

2型糖尿病、糖耐量减低患者心率变异性测定

目的观测2型糖尿病(T2DM)、糖耐量减低(IGT)患者心率变异(HRV)的变化及对早期心脏自主神经病变的意义。方法应用24h全信息动态心电检测仪,分别测定T2DM组(32例),IGT组(30例),正常对照组(32例)的HRV时域指标:总体标准差(SDNN),均值标准差(SDANA),连续5min正常R-R间期标准差的均值(SDNNindex),差值均方的平方根(RMSSD)和爱丁堡指数(PNN50),并分别比较三组间HRV时域指标的差异。结果三组间HRV时域指标存在统计差异;T2DM组HRV的五项指标均低于IGT组和正常对照组(P<0.01);IGT组HRV的五项指标中SDNN、SDANN、SDNNindex三项低于正常对照组(P<0.01),其余二项指标RMSSD、PNN50与正常对照组无显著性差异。结论T2DM的HRV改变提示T2DM早期已出现心脏自主神经的病变I。GT患者HRV的部分异常,提示在糖尿病(DM)前期部分患者已存在不同程度的心脏自主神经的功能紊乱。HRV测定在预测早期DM心脏自主神经病变中,具有准确、灵敏、简便、无创性等特点,应予重视。     

肠易激综合征患者心血管自主神经功能变化与心率变异性的关系

目的 :探讨肠易激综合征 (1BS)患者心血管自主神经功能变化与心率变异性 (HRV)的关系。方法 :对IBS患者 50例进行标准心血管自主神经功能测试 ,将其结果分成阳性组 (DNA+ )及阴性组 (DNA- ) ,健康人 30名为对照组。 2 4h动态心电图进行HRV分析。结果 :IBS患者自主神经功能异常的发生率为 58% ,主要表现为迷走神经功能异常 ;HRV时域分析中DNA+ 组SDNN、SDANN、SDNNindex明显减少 ;DNA+ 及DNA- 组中反映副交感神经张力的RMSSD、PNN50 、HF等指标明显增高 ,LF/HF比值明显减低 ,与对照组比较有显著性差异 (P <0 .0 5)。结论 :IBS患者存在副交感神经张力增加。HRV分析是发现IBS患者自主神经功能异常的较好方法     

手汗症患者行胸交感神经干切断术后心率变异性的变化

目的观察手汗症患者行胸交感神经干切断手术前后心率变异性(HRV)的变化,评估胸交感神经干切断术对患者心脏自主神经系统功能的影响。方法选择本院接受胸交感神经干切断术(T3～T4或T2～T4)的手汗症患者20例,记录入院后第1天和术后24h12导联24h动态心电图,检测HRV的时域和频域指标并进行对比分析。结果与术前比较,胸交感神经干切断术后手汗症患者的全程记录中第5min正常RR间期平均值的标准差、相邻正常RR间期差值的均方根和相邻RR间期差值50ms的百分比升高(P均0.05),低频降低(P0.05),高频、低频/高频和连续24h内正常RR间期的标准差无差异。结论手汗症患者行胸交感神经干切断术后HRV增加,可能与术后交感神经系统的张力降低,而迷走神经紧张性相对增高,患者自主神经系统的平衡性得到改善有关。     

Apgar评分与重度窒息新生儿心率变异性的关联性探讨

目的探讨Apgar评分与重度窒息新生儿心率变异性(HRV)的关联性。方法选择2010-10~2014-05出生窒息的新生儿63例及健康新生儿40名作为观察对象,将所有新生儿的心电图进行24 h全程动态记录,对24 h窦性心律进行HRV时域分析,分析指标包括正常窦性心律RR间期标准差(SDNN)、每5 min RR间期平均值标准差(SDANN)、每5 min RR间期标准差平均值(SDNNindex)、相邻RR间期差值的均方根值(RMSSD)、正常RR间期标准差50 ms的百分比(PNN50)。根据窒息新生儿出生后5 min Apgar评分,将所有窒息新生儿分为Apgar≤7分(重度窒息组21例),Apgar7分(轻度窒息组42例)。所有新生儿于出生后第3天行动态心电图检查,对比HRV变化。结果重度窒息组、轻度窒息组最慢心率、最快心率、平均心率显著低于健康对照组(P0.05),而重度窒息组又显著低于轻度窒息组(P0.05);重度窒息组、轻度窒息组的SDNN、SDANN显著低于健康对照组(P0.05),而重度窒息组又显著低于轻度窒息组(P0.05)。结论新生儿窒息会造成自主神经功能损伤,Apgar评分联合HRV时域参数可作为新生儿自主神经功能损伤判断的指标,可以较好地反映窒息缺氧严重程度。     

慢性充血性心力衰竭患者心率变异性及其昼夜节律变化

目的分析慢性充血性心力衰竭(CHF)患者心率变异性(HRV)及其昼夜节律的变化,了解CHF患者自主神经功能损害与心功能的关系。方法用24小时动态心电图分析38例CHF患者,20例心功能代偿的心血管病患者心功能代偿组,16例健康体检者对照组的HRV时域指标。比较三组间HRV指标的差异;计算CHF患者HRV昼夜指标差异,分析CHF患者24小时HRV指标变化与心功能NYHA分级的关系。结果心功能代偿组24小时HRV时域指标SDNN、SDANN和SDNNindex较对照组显著下降P<0.01、0.05和0.05rMSSD和pNN50与对照组无显著差别P>0.05;CHF组的HRV各指标均显著低于对照组均P<0.01且昼夜指标变化无差异;将CHF组分为心功能Ⅱ级组n=20和心功能≥Ⅲ级n=18两个亚组结果发现心功能≥Ⅲ级的HRV各指标明显低于心功能Ⅱ级组P<0.01。结论心血管病患者可能在心功能代偿期时自主神经的平衡就已受到损害当出现CHF时交感活性增强迷走神经张力进一步下降,自主神经调节昼夜节律性丧失,且HRV指标的下降与心功能损害程度相关因此HRV时域指标可作为评价CHF预后指标之一。     

高血压脑卒中患者心率变异性与心率减速力的变化分析

目的通过对高血压脑卒中患者心率减速力(DC)、心率变异性(HRV)相关指标的分析,探讨上述检查在评估自主神经功能方面的作用。方法连续选取2014年5月—2015年5月在我院进行诊治的50例单纯高血压病患者作为A组;77例高血压脑卒中患者作为B组;同时,选取同期门诊体检的51名健康者作为对照组。所有入选者进行24 h动态心电图检查,检测DC、HRV相关指标,包括时域指标:RR总体标准差(SDNN)、24 h每5 min RR间期平均值的标准差(SDANN)、差值均方根值(r MSSD)、相邻RR间期差值50 ms的百分数(PNN50),频域指标:低频功率(LF)、高频功率(HF)及两者比值(LF/HF)。结果 A组与对照组比较,除LF/HF外其他各项指标差异均有统计学意义(P0.05);B组与对照组比较,DC与HRV指标差异均有统计学意义(P0.05),A组与B组比较,DC、SDNN、SDANN、LF/HF差异有统计学意义(P0.05),其他指标差异无统计学意义。Pearson相关分析发现,高血压脑卒中患者DC与SDNN、r MSSD、PNN50之间呈正相关性(r值分别为0.572、0.663、0.764,P0.05)。结论高血压合并脑卒中患者心率减速力与心率变异性呈正相关性,进行DC、HRV的检测可以有效地评价高血压脑卒中患者的自主神经受损情况。     

肾脏病患者心率变异性的临床分析

目的 :用心率变异性 （HRV）观察肾脏病及肾功不全患者变化。方法 :选择肾功正常的肾病患者 2 6例 ,肾功不全患者 34例 ,正常对照组 34例。用 2 4h动态心电图分析其 HRV的时域指标。结果 :肾功正常肾病组平均 RR间距期 （RR I）、2 4h窦性 R- R间期标准差 （SD）、5 min窦性 R- R间期标准差 （SDAIDX）显著低于正常组 （P<0 .0 5 ） ;肾功不全组 6项指标均明显低于正常对照组 ,SD,5 min窦性 R- R间期标准差的均值 （SDIDX） ,SDAIDX,及 R- R连续差异均方根 （r MSSD）显著低于肾功正常组。结论 :肾脏病患者在肾功正常期即有自主神经功能损伤 ,以交感神经活动受损主为 ;肾功不全患者交感神经及迷走神经功能均受损     

2型糖尿病患者心率变异性分析

目的分析2型糖尿病患者心率变异性(HRV)及其影响因素。方法对91例2型糖尿病患者和75名健康者进行24 h动态心电图监测,并测定HRV时域指标[正常RR间期的标准差(sDNN),5 min平均RR间期的标准差(sDANN),相邻RR间期之差的均方根值(RMSSD),爱丁堡指数(PNN50)]和频域指标低频[(LF)/高频(HF)],测定2型糖尿病患者的糖化血红蛋白(GHB)、空腹胰岛素(FINS)、空腹C肽(FCP)、空腹血糖(FBS)、餐后血糖(PBS)、餐后2 h胰岛素(PINS)、餐后2 h c肽(PCP)。结果 2型糖尿病患者HRV指标较健康者显著降低,RMSSD、LF/HF差异有统计学意义(P<0.05)。HRV指标SDNN、RMSSD与GHB呈负相关。结论 2型糖尿病患者HRV降低,提示心脏自主神经功能受损,它受GHB的影响。     

原发性高血压伴慢性肾功能不全患者心率变异性分析

目的：探讨原发性高血压（EH）伴慢性肾功能不全患者心率变异性（HRV）特点。方法：选择EH患者50例,其中合并慢性肾功能不全患者22例为肾功能不全组,肾功能正常患者28例为肾功能正常组,进行24h动态心电图监测（Holter）,分析HRV各项指标,应用HRV的时域分析和频域分析评价EH合并慢性肾功能不全患者心率变异性特点。结果：与肾功能正常组比较,肾功能不全组24h内正常窦性R-R间期标准差（SDNN）[（142.11±52.48）ms比（100.23±30.68）ms]、24h内连续每5min正常R-R间期平均值的标准差（SDANN）[（140.51±69.21）ms比（99.44±52.69）ms]、24h内差值超过50ms的连续正常的R-R间期数所占的百分数[PNN50（%）][（21.81±12.21）%比（15.49±10.21）%]、24h内相邻R-R间期差的均方根（rMSSD）[（36.44±30.29）ms比（28.67±21.3）ms]、高频成分的归一化值（HFnu）均明显降低[（42.97±19.11）比（29.41±3.89）],低频成分的归一化值（LFnu）[（52.81±12.26）比（80.32±16.69）]明显升高（P〈0.05）。结论：原发性高血压伴慢性肾功能不全患者较单纯高血压患者自主神经功能受损更为明显,心率变异性可评估其预后。     

T‐Wave Alternans and Heart Rate Variability: A Comparison in Patients with Myocardial Infarction with or without Diabetes Mellitus

Background : The aim of this study was to investigate the differences in T‐wave alternans (TWA) and heart rate variability (HRV) among patients with myocardial infarction with or without diabetes mellitus and the relationship between TWA and HRV. Methods: The study population included 133 patients: 59 patients with myocardial infarction (MI) (group post‐MI without diabetes); 40 myocardial infarction with diabetes (group post‐MI with diabetes); and 34 controls (group control). Cardiac autonomic neuropathy assessment was made using frequency domain (low‐frequency [LF] power, high‐frequency [HF] power, LF/HF) and time domain (SDNN, standard deviation of the averaged normal sinus RR intervals for all 5‐minute segments [SDANN]) of HRV indexes. Both TWA and HRV were measured on the Holter monitor, and TWA was calculated automatically using the time‐domain modified moving average method. Results: TWA values differed significantly between controls (40 ± 16 μV) and group post‐MI with (62 ± 17 μV, P < 0.05) or without (60 ± 15 μV, P < 0.05) diabetes. In addition, group post‐MI with diabetes had lower standard deviation of all normal sinus RR intervals (SDNN), standard deviation of the averaged normal sinus RR intervals for all 5‐minute segments (SDANN), and HF, indicating depressed vagus nerve activity, and higher LF/HF ratio, indicating elevated sympathetic nerve activity, than controls and group post‐MI without diabetes (P < 0.05). TWA correlated with SDNN and SDANN (r = 0.29, 0.31; P < 0.001). Conclusions: TWA was elevated in patients following myocardial infarction, both in those with or without diabetes. Myocardial infarction patients had a lower time domain, HF, and a higher LF/HF ratio HRV, especially in those with diabetes. The analysis of modified moving agerage (MMA)‐based TWA and HRV can be a useful tool for identifying post–myocardial infarction patients at high risk of arrhythmic events. Ann Noninvasive Electrocardiol 2011;16(3):232–238     

Cardiac Autonomic Function and Reactivity Tests in Physically Active Subjects with Moderately Severe COPD

Patients with chronic obstructive pulmonary disease (COPD) show impairments in the autonomic nervous systems (ANS) function, which is responsible for cardiac autonomic regulation. This study assessed the autonomic function and cardio-vagal reactivity in conveniently sampled subjects with COPD participating in a pulmonary rehabilitation (PR) program. Twenty-six subjects with COPD and 22 age and gender matched control subjects were evaluated. R-R intervals were collected at rest in supine position. Thereafter, resting autonomic function parameters comprising linear and nonlinear analyses of heart rate variability (HRV) and baroreceptor sensitivity (BRS) were calculated. Autonomic reactivity tests comprising deep breathing (DB), Valsalva maneuver (VM), and head up tilt (HUT) were also performed. The results of this study indicated that resting autonomic function variables were generally reduced in COPD compared to controls. However, this difference was only statistically significant for a few HRV parameters: mean RR intervals, low frequency (LF), standard deviation of dispersion of points perpendicular to the line-of-identity (SD1), and approximate entropy (ApEn) (p < 0.05). The results also indicated that all cardio-vagal indices following the autonomic reactivity tests were comparable between COPD and controls (p > 0.05). It was concluded that subtle autonomic impairments exists in physically active COPD patients, and these autonomic function deficits were mainly recognized by resting HRV indices and not autonomic reactivity tests.     

Sex Differences in Short‐Term Heart Rate Variability in Patients With Newly Diagnosed Essential Hypertension

The authors report the results of the analysis of heart rate variability (HRV) indices during 5 minutes of supine rest and 5 minutes of standing and conventional indices of autonomic function in 69 men and 51 women with untreated newly diagnosed hypertension matched for body mass index and resting blood pressure. Mean RR interval, standard deviation of normal‐to‐normal RR intervals, low‐frequency RR spectral power, HRV during deep breathing at 6 breaths per minute, and the 30:15 ratio (maximum RR interval 30th beat/minimum RR interval 15th beat) were significantly lower in women (P=.01, .02, .001, .04, .01, respectively) compared with men. Low frequency RR in normalized units was lower in women in the supine position alone (P=.03). HRV was significantly lower in women with untreated newly diagnosed hypertension compared with men. The authors interpret these results as indicating an increase in baseline cardiac sympathovagal balance in female hypertensive patients.     

高血压病患者胰岛素抵抗与心率变异的关系

目的探讨高血压病患者心率变异指标变化和胰岛素抵抗之间的关系。方法３７例高血压病患者和１６例正常人行糖耐量试验和测定胰岛素释放曲线的同时测定心率变异各项指标。结果高血压病人中６２％存在高胰岛血素症和胰岛素抵抗，其２４小时ＲＲ间期均值的标准差指数（ＳＤＮＮＩ）明显高于正常人，而２４小量内ＲＲ间期的标准差（ＳＤＮＮ）５分钟ＲＲ间期均值标准差指数（ＳＤＡＮＮＩ）和相邻心搏ＲＲ间期差值的均方根（ｒＭＳＳＤ）及相邻心搏ＲＲ间期大于５０ｍｓ的百分比（ＰＮＮ５０）明显低于正常人。结论高血压病患者的心率变异和胰岛素抵抗所引起的交感神经增强和副交感神经的活性减弱有关     

Increased sympathetic nervous system activity as cause of exercise-induced ventricular tachycardia in patients with normal coronary arteries

In this prospective study, we set out to determine whether analysis of heart rate variability (HRV) in patients with exercise-induced ventricular tachycardia (EIVT) and normal coronary arteries would reveal increased sympathetic nervous system activity. From January 1996 to December 2001, we compared 16 patients with EIVT and normal coronary arteries with an age- and sex-matched control group. Analysis of HRV showed that parameters indicative of parasympathetic activity were lower in our study group than in our control group: standard deviation of the mean of qualified NN intervals (SDNN), 81.6 +/- 14.5 vs 139.3 +/- 11.0, P <0.001; root mean square of successive differences (RMSSD), 22.3 +/- 4.8 vs 36.3 +/- 6.6, P <0.001; number of NN intervals that differed by more than 5 ms from the adjacent interval, divided by the total number of NN intervals (PNN50), 4.8 +/- 1.5 vs 10.2 +/- 3. 1, P <0.001; and high-frequency component (HF), 28.7 +/- 2.5 vs 32.4 +/- 3.9, P <0.05. Conversely, parameters indicative of sympathetic activity were higher in patients with EIVT: low-frequency component (LF), 71.2 +/- 5.0 vs 52.0 +/- 5.8, P <0.001; and absolute low/high frequency component ratio (LF/HF), 2.7 +/- 0.2 vs 1.6 +/- 0.2, P <0.001. There was a positive correlation between EIVT and LF (r=0.79, P <0.001) and between EIVT and LF/HF (r=0.81, P <0.001). Our results suggest the presence of increased sympathetic and decreased parasympathetic tone in patients with EIVT. We conclude that EIVT is associated with an imbalance in the autonomic nervous system.     

高血压合并2型糖尿病患者心率变异性分析

目的：分析高血压合并2型糖尿病患者的心率变异性（heart rate variability,HRV）。方法收集本院收治的60例高血压合并2型糖尿病患者作为A组、60例高血压患者作为B组、60例正常体检者作为C 组。对3组研究对象均行24 h 动态心电图记录。比较各组的HRV指标。结果 A组患者的1 d内正常RR标准差（SDNN ）、5 min时段RR间期均值标准差（SDANN）、5 min 节段 RR 间期平均值标准差（SDNN index）,连续 RR 间期差值均方根（rMSSD）和相邻正常 RR 间期差值＞50 ms 百分比（pNN50）分别为（97．88±25．77）ms、（83．24±20．13）ms、（14．55±10．57）ms、（17．95±8．55）ms、（3．56±2．44）％,显著低于B组的（122．41±20．33）ms、（104．56±19．73）ms、（45．22±12．45）ms、（22．44±6．44）ms、（8．83±4．95）％和C组的（138．23±22．44）ms、（127．95±21．84）ms、（59．35±16．44）ms、（35．96±14．33）ms、（13．56±11．24）％。B组亦低于C 组,差异均有统计学意义（P＜0．05）。结论利用HRV 可在早期有效发现高血压合并2型糖尿病患者自主神经功能损伤程度,安全可靠,值得临床推广。     

Heart Rate Variability for Evaluating Surgical Stress and Development of Postoperative Complications

Heart rate variability (HRV) has recently been used to detect autonomic nerve tone, which is affected by various stresses. To test out hypothesis that HRV can determine surgical stress, we examined perioperative HRV in 30 patients with surgical treatment. Relations between HRV and factors of surgical stresses, such as duration of the operation, amount of blood loss at the operation, and developments of complications, were evaluated. Mean heart rate (HR) increased and other HRV indices decreased postoperatively. Most indices correlated significantly to the duration of the operation and amount of blood loss at the operation on postoperative day 1. Only the standard deviation of normal to normal RR intervals (SDNN) and HRV triangular index showed significantly low values in complicated patients. HRV measurement in the perioperative period showed a significant relation to surgical stress. The present results indicated that HRV may provide useful information with respect to surgical stress.     

Heart rate variability for evaluating surgical stress and development of postoperative complications

Heart rate variability (HRV) has recently been used to detect autonomic nerve tone, which is affected by various stresses. To test out hypothesis that HRV can determine surgical stress, we examined perioperative HRV in 30 patients with surgical treatment. Relations between HRV and factors of surgical stresses, such as duration of the operation, amount of blood loss at the operation, and developments of complications, were evaluated. Mean heart rate (HR) increased and other HRV indices decreased postoperatively. Most indices correlated significantly to the duration of the operation and amount of blood loss at the operation on postoperative day 1. Only the standard deviation of normal to normal RR intervals (SDNN) and HRV triangular index showed significantly low values in complicated patients. HRV measurement in the perioperative period showed a significant relation to surgical stress. The present results indicated that HRV may provide useful information with respect to surgical stress.