脑卒中患者心率变异性特征研究

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(rMSSD)、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、rMSSD、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、rMSSD、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.

A Characteristics Study on Heart Rate Variability in Patients with Cerebral Apoplexy

Objective To observe the heart rate variability ( HRV) of cerebral apoplexy and non cerebral apo-plexy patients so as to investigate the effects of cerebral apoplexy on HRV. Methods A total of 72 cerebral apoplexy pa-tients admitted during July 2012 and September 2013 were selected as the observation group, and 80 non cerebral apo-plexy 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 ad-mission 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 (rMSSD), 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, rMSSD, 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 af-ter 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, rMSSD 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.