老年心力衰竭患者自主神经功能与心率变异性关系的研究

目的探讨老年充血性心力衰竭(CHF)患者自主神经功能活动与心功能受损的严重程度及与临床的相关性。方法分析61例老年CHF患者和30例对照者的心率变异性时域指标及临床相关指标。结果(1)CHF组与对照组比较,HRV各测值均显著降低(P<0.01)。(2)HRV各测值均随心功能的下降而呈递减性下降,在心功能各级别间具有显著差异(P<0.05~0.01)。(3)除RV及E/A比值无显著差异(P>0.05)外,LVd、LVs、LVPWI、VS、LVEF均随心功能下降而呈显著改变(P<0.05~0.01)。(4)SDNN和TI下降与心功能NYHA分级、LVd和LVs、LVPW及IVS呈负相关(P<0.05~0.01),而与LVEF、E/A比值呈正相关(P<0.05~0.01)。结论老年CHF患者存在着严重的自主神经功能受损和失衡,且与心功能损害、左心室肥大以及左心室收缩与舒张功能减退的程度密切相关,HRV检测有助于老年CHF的早期诊断、心力衰竭的严重程度与预后的评估以及指导治疗。

Study on Heart Rate Variabililies (HRV) for Evaluation of the Automatic Nervous Functions and Clinical Correlative Factors in Senile Patients with CHF.

Objective To inquire into the eoherences between automatic nervous functional actions and injury degrees of heart function as well as their corresponding clinical factors in senile patients with congestive heart failure （CHF）. Methods 61 senile cases of CHF （CHF group） and 30 eases of healthy people （control group） were studied and their heart rate variabilities （HRV） and correlative clinical indexes were analyzed. Results （1） Compared with the control group, the various determined HRV values in CHF group decreased signitieantly （ P 〈0.01）. （2）The various determined HRV values decreased gradually according to the damage of heart function, and there were significant differences among the values of HRV in patients with different-grade heart function （ P 〈 0.05 0.01）. （3） LVd, LVs, LVPW, IVS and LVEF changed significantly with the damage of heart function （ P 〈0.05 -0.001）, except for the changes of R V and E/A（ P 〉 0.05 ）. （4）The decreases of SDNN and TI were negatively con＇elation with the NYHA grades of heart function, LVd, LVs, LVPW and IVS （ P 〈 0.05 - 0.01）, but were positively con＇elation with the LVEF and E/A（ P 〈 0.05 - 0.01 ）. Conclusion There were severe injuries and imbalances of automatic nervous system in senile patients with CHF, and they were closely correlation with the degrees of heart function damage, left ventrieular hypertrophy, hypofunetion of left ventrieular contraction and diastolization. It is helpful to determine HRV for the early diagnosis, evaluations of severeness, prognosis and treatments of heart failure in the patients with CHF.