原发性高血压合并ST-T改变者心律失常检测与心率变异性分析

目的 研究原发性高血压合并ST-T改变患者的心律失常及心率变异性特点.方法 选择24h 12导联同步动态心电图检测的原发性高血压合并ST-T改变患者(Ⅰ组)65例,非合并ST-T改变患者(Ⅱ组)70例,年龄、性别相匹配的健康对照者(Ⅲ组)65例,对房性早搏和室性早搏起源部位进行分析,对比3组心律失常情况及心率变异性时域指标.结果 3组房性心律失常发生率差异具有统计学意义(P＜0.05),但房性早搏起源部位差异无统计学意义(P>0.05);室性心律失常发生率差异具有统计学意义(P＜0.05),Ⅰ组和Ⅱ组左、右心室心尖部早搏发生率均高于Ⅲ组(P＜0.05),其中左心室心尖部早搏发生率Ⅰ组高于Ⅱ组(P＜0.05);3组心率变异性时域指标Ⅰ组与Ⅱ、Ⅲ组比较差异具有统计学意义(P＜0.05),Ⅱ组与Ⅲ组比较差异无统计学意义(P>0.05).结论 原发性高血压合并ST-T改变患者房性和室性心律失常发生率均明显增高,左心室心尖部早搏发生率高,心率变异性降低.     

老年原发性高血压患者血压昼夜节律与左室重构的相关性研究

目的探讨老年原发性高血压（EH）患者血压昼夜节律与左心室肥厚的关系。方法对158例EH患者伴或不伴左心室肥厚（LVH）和129例正常健康老年人（对照组）采用水银血压计和24h动态血压（ABPM）各指标进行组间及组内比较,同时与心脏超声资料进行相关性分析。结果（1）EH患者伴LVH组和NLVH组与对照组24h各时间段的血压均值有统计学意义（P〈0．05）;LVH组中24hSBP、dSBP、nSBP均明显高于NLVH组（P〈0．05）,而24hDBP、dDBP、nDBP的差异无统计学意义（P〉0．05）。（2）LVH组白昼收缩压、舒张压水平与夜间差异无统计学意义（P〉0．05）,而NLVH组白昼收缩压、舒张压水平高于夜间（P〈0．05）。（3）LVH非勺型组发生率高于勺型者（P〈0．05）。（4）收缩压水平与LVMI的相关性比舒张压密切,而夜间收缩压、舒张压水平与LVMI的相关性比白天更密切。结论老年EH患者存在明显节律紊乱,且左室肥厚主要与收缩压和脉压水平有关。     

齐拉西酮对首发男性精神分裂症患者心率及变异性的影响

目的 研究齐拉西酮对首发精神分裂症男性患者的心率及变异性影响,为临床安全用药提供参考.方法 将2011年1月～2012年10月收治的首发精神分裂症男性患者61例纳入研究,给予齐拉西酮治疗;健康体检者63例作为对照组,比较治疗前两组心率及变异性的指标差异以及齐拉西酮治疗8周前后心率变异性的指标差异,了解齐拉西酮对精神分裂症男性患者的心率变异性影响.结果 在基线时,研究组和对照组相比,HR及HRV所有指标(SDNN、SDNNi、PNN50、SDANN)的差异均有统计学意义(P＜0.01);研究组治疗8周前后比较,除SDNNi外,其余指标的差异均有统计学意义(P＜0.01);研究组治疗8周后,与对照组比较,除PNN50外,其余指标的差异均有统计学意义(P＜0.01).结论 精神分裂症患者存在心率变异性下降,交感神经张力增加,迷走神经张力降低,有可能增加心源性猝死的几率,齐拉西酮的治疗可能加重其影响;故对于使用齐拉西酮治疗的精神分裂症男性患者需要加强观察以及实行心率变异性的监测,以加强医疗安全.     

联合用药治疗高血压左室肥厚的临床观察

目的 研究卡托普利与络活喜联合应用对高血压左室肥厚(LVH)患者的左室结构的影响. 方法 76例原发性高血压左室肥厚患者随机分为2组:治疗组口服卡托普利25mg,3次/d;对照组口服卡托普利25mg,3次/d与络活喜5mg/d.平均12个月,观察用药后血压、左室结构的变化. 结果 用药后2组收缩压(SBP)和舒张压(DBP)均显著降低(P＜0.01);室间隔厚度(IVST)及左室后壁厚度(LYPWT)均变薄(P＜0.01),左室重量指数(LYMI)明显减少(P＜0.01). 结论 对原发性高血压左室肥厚的患者,长期应用卡托普利具有良好降压效果,同时还可逆转LVH,改善患者预后.     

高血压合并急性脑血管病的心率变异分析

目的：探讨急性脑组织损害对原发性高血压（EH）患者心率变异（HRV）的影响。方法：对26例EH并急性脑血管病（ACVD）患者进行24h动态心电图HRV测定,并与20例EH元ACVD患者进行对比。结果:EH并ACVD组最小心率及平均心率明显高于无ACVD组（P＜0．01;P＜0．01）;24h相邻R-R间期之差的均方根（rMSSD)、相邻R-R间期之差大于50ms的心搏数占心搏总数的百分比（PNN50）较无ACVD组明显减低（P＜0．01;P＜0．001）。结论：EH合并ACVD患者HRV低于EH无ACVD患者,与其自主神经中枢损害有关。     

肌电生物反馈对高血压前期患者心率变异性的影响

目的 研究肌电生物反馈对高血压前期患者血压及心率变异性(HRV)的影响.方法 观察分析12例进行生物反馈放松训练的高血压前期患者与12例对照者血压值及HRV的时域指标与频域指标.结果 与对照组相比,生物反馈组的收缩压下降趋势显著(P＜0.05),且至少可以维持6个月,心率下降趋势较显著(P＜0.05),SDNN和HF有明显升高的趋势(P＜0.05),LF和LF/HF明显降低(P＜0.05).结论 肌电生物反馈可以使高血压前期患者的血压降低至理想范围,其机制可能主要与HF升高、副交感神经的兴奋性增高有关.     

高血压合并左室肥厚患者晚期糖基化产物与血管紧张素Ⅱ的相关性研究

目的探讨血清晚期糖基化产物（AGEs）与血浆血管紧张素Ⅱ（AngⅡ）在原发性高血压（EH）合并左心室肥厚（LVH）患者中的水平及二者的相关性。方法分别用双抗体夹心酶联免疫吸附试验（ELISA）及放射免疫法（RIA）测定50例健康者（对照组）,85例高血压患者的血清AGEs及血浆AngⅡ含量。根据LVMI把高血压患者分为52例EH患者（EHN-LVH组）和33例EH合并LVH患者（EHLVH组）。结果与对照组比较,EH组AngⅡ、AGEs含量均增高,EHNLVH组P〈0.05,EH-LVH组P〈0.01;相关性分析显示EH患者AGEs与AngⅡ呈正相关;LVMI值与AGEs、AngⅡ呈正相关。结论AGEs和AngⅡ与EH及EH-LVH的发生发展有关,且二者存在相互作用。     

血浆尾加压素Ⅱ水平与高血压左心室肥厚的相关性分析

目的探讨原发性高血压血浆尾加压素Ⅱ(U-Ⅱ)水平与左心室肥厚(LVH)的关系。方法选取我院高血压门诊原发性高血压患者106例,应用心脏彩色超声心动图检测患者左心室质量指数(LVMI),根据左心室质量指数将高血压患者分为高血压伴左心室肥厚组(EH-LVH)和高血压非左室肥厚组(EH-NLVH),采用放射免疫法检测血浆U-Ⅱ水平。同时选择同期健康体检者50例作为正常对照组。结果 EH-LVH组血浆U-Ⅱ水平(4.8±1.5)μmol/L,明显高于正常对照组(2.0±1.3)μmol/L,差异有统计学意义(P<0.05)。EH-NLVH组(1.8±1.6)μmol/L,与正常对照组比较差异无统计学意义(P>0.05)。直线相关分析显示血浆U-Ⅱ水平与LVMI呈正相关(r=0.518,P<0.01)。结论血浆U-Ⅱ水平与高血压合并左心室肥厚显著相关,血浆U-Ⅱ可能是高血压左心室肥厚疾病发生发展的主要因素之一。     

癌症相关创伤后应激障碍患者心率变异性研究

目的:探讨癌症相关创伤后应激障碍(PTSD)患者的心率变异性(HRV). 方法:采用临床用创伤后应激功能障碍诊断量表(CAPS)对150例癌症患者进行诊断性访谈,并分为PTSD组(37例)和非PTSD组(nPTSD组,30例);应用PTSD自评量表(PCL-C)对两组患者进行评估;采用生理相干与自主神经平衡系统对PTSD组、nPTSD组、健康对照(NC)组(30名)进行短时HRV检测,分析HRV指标与PTSD核心症状的相关性. 结果:与nPTSD组和NC组比较,PTSD组平静状态下R-R间期标准差(SDNN)和高频功率(HF)较显著下降,低频功率(LF)/HF显著升高(P均＜0.001);应激状态下PTSD组SDNN应激差值明显降低,HF和LF/HF应激差值显著增高(P均＜0.001);HRV指标与PTSD核心症状的严重程度显著相关(P均＜0.05). 结论:癌症相关PTSD患者自主神经功能紊乱,其核心症状的严重程度与自主神经功能紊乱显著相关.     

帕金森病患者心血管自主神经功能障碍的临床研究

目的研究帕金森病(PD)患者心血管自主神经功能障碍及其相关的影响因素。方法入选PD患者(PD组)51例和健康对照者(对照组)30例,分别进行24 h动态血压和动态ECG监测,对比分析两组的血压变异性(BPV)和心率变异性(HRV)的指标,同时对PD患者进行左旋多巴等效剂量(LED)换算、Hoehn-Yahr分期(H-Y分期)和统一PD评定量表Ⅲ(UPDRSⅢ)评分,探讨BPV和HRV的影响因素。结果 PD组BPV中24h SBPSD、dSBPSD、nSBPSD较对照组明显升高(均P0.05)。PD组HRV中SDNN、RMSSD、HF、LF较对照组明显下降(均P0.05)。PD患者BPV与病程具有正相关(P0.05),HRV与病程、H-Y分期、UPDRSⅢ评分具有负相关(均P0.05)。结论 PD患者存在心血管自主神经功能障碍,且与病程、疾病严重程度及运动症状严重程度有关。     

非洛地平对高血压左心室肥厚的影响

目的 探讨非洛地平对原发性高血压左心室肥厚的影响.方法 将60例伴有左心室肥厚的高血压病人随即分成2组,非洛地平组30例,用非洛地平2.5～5mg,苯那普利组30例,用苯那普利10～20mg,均1次/d,晨服,疗程24周,观察用药前后血压、左心室重量指数(LVMI)等指标变化.结果 2组病人治疗后血压、室间隔及左室后壁厚度、左室重量指数等指标均较用药前显著下降(P＜0.01),而2组间比较无明显差别.结论 长效钙离子拮抗剂非洛地平可减轻高血压病人左心室肥厚,疗效与血管紧张素转换酶抑制剂相同,且显著降低血压,不良反应小.     

微创开颅四脑室血肿清除联合脑室外引流治疗重型脑室出血临床观察

目的探讨微创开颅四脑室血肿清除联合脑室外引流治疗重型脑室出血的临床疗效。方法筛选2016-01—2018-01新乡市中心医院收治的58例自发性重型脑室出血患者,随机分为开颅组(行微创开颅四脑室血肿清除联合脑室外引流术)和对照组(单纯行双侧脑室外引流术)各29例。比较2组患者术前与术后24 h GCS评分、术后3 d脑室内血肿清除率、脑室引流管带管时间、术后并发症(再出血、颅内感染、脑积水)发生率、术后6个月存活患者日常生活能力(ADL)评分。结果开颅组患者术前与术后24 h GCS评分比较,差异有统计学意义(P<0.05);开颅组术后3 d脑室内血肿清除率、脑室引流管带管时间、术后并发症发生率及术后6个月存活患者ADL评分与对照组比较,差异均有统计学意义(P<0.05),开颅组治疗效果优于对照组。结论采用微创开颅四脑室血肿清除联合脑室外引流术治疗重型脑室出血,能明显改善患者预后。     

Heart rate variability in children with idiopathic ventricular tachycardia

Idiopathic ventricular tachycardia (IVT) is a rare arrhythmia in children. A great deal of uncertainty and numerous questions still remain regarding the extent of investigation, therapy, and long-term prognosis for children with IVT. The existence of subclinical cardiac disease, as well as of autonomic dysfunction in patients with ventricular arrhythmias, has been well documented. A number of experimental and clinical studies have suggested that imbalances within the cardiac autonomic system’s activity may be crucial in the generation of ventricular tachycardia, irrespective of the presence of cardiovascular pathological substrate. Heart rate variability (HRV) analysis provides a useful method for measuring the autonomic activity. This study evaluates HRV in children with IVT. The study included 31 children with ventricular arrhythmia who were divided into two groups: (1) patients with frequent ventricular extrasystoles (VES) and (2) patients with IVT. The control group comprised 23 healthy children without pathological findings on 24-h ECG Holter. Twenty-four-hour ambulatory electrocardiography recordings were obtained, and the time-domain variables were calculated. HRV was compared to age-related normal values. It was observed that the overall heart rate variability is diminished in children with IVT. We recommend HRV analysis of any child with IVT. Quantification of the autonomic nervous system activity using time domain analyses may be a helpful diagnostic tool in the clinical assessment and initial evaluation of these children. Departments at which the work was done: Clinic of Pediatrics, Clinical Center, Nis and University Children’s Hospital, Belgrade, Serbia     

原发性高血压患者左室舒张功能与血清瘦素浓度的关系

目的 探讨原发性高血压(EH)患者左室舒张功能与血清瘦素(Leptin)浓度关系的临床研究。方法 采用放免法测定30例正常人和54例EH患者的血清瘦素浓度。用多普勒组织成像(DTI)技术检测正常人及EH患者二尖瓣环舒张早期运动速度(Ea)、舒张晚期运动速度(Aa)及Ea/Aa,比较其测定值与血清瘦素浓度的相关性。结果 患者组二尖瓣环DTI参数明显低于正常对照组(P<0.01);患者组血清瘦素浓度与Ea、Ea/Aa呈负相关(r=-0.41 P<0.01,r=-0.43 P<0.01)。结论 检测血清瘦素浓度有利于EH患者左室舒张功能受损程度的判断。     

Changes in autonomic cardiac control in patients with epilepsy after discontinuation of antiepileptic drugs: a randomized controlled withdrawal study

The aim of this study was to assess cardiac autonomic control in patients with epilepsy before and after withdrawal of antiepileptic drugs (AEDs). The study was prospective, randomized and double blinded. Spectral analysis of heart rate variability (HRV) in 24 h ECG-registration before and after withdrawal of AEDs was used to assess autonomic cardiac control. The assessment of HRV with spectral analysis was based on sinus rhythm and normal heart beats [normal to normal beat (NN)]. Thirty-nine patients had 24 h rhythms free from any ectopic beats both before and after intervention, and were included in the analysis. Significant differences were found in the withdrawal group: filtered RR intervals for all 5 min segments of the analysis; percentage of differences between adjacent filtered RR intervals that are greater than 50 ms for the whole analysis; very low frequency power; low frequency power and high frequency power. The results demonstrate that slow withdrawal of AEDs in seizure-free patients with epilepsy on drug mono-therapy resulted in an increase in both parasympathetic and sympathetic functions, indicative of increased power amongst patients following cessation of AED treatment. As low HRV has been associated with increased mortality in patients with other diseases, this increased HRV may be beneficial.     

Increased prevalence of silent myocardial ischaemia and severe ventricular arrhythmias in untreated patients with Alzheimer's disease and mild cognitive impairment without overt coronary artery disease

OBJECTIVE: To assess the prevalence and the characteristics of silent myocardial ischaemia (SMI) and ventricular arrhythmias (VA) in subjects with Alzheimer's disease (AD) and mild cognitive impairment (MCI) and their relationships with QT interval dispersion (QTD). METHODS: Thirty-three subjects with AD, 39 subjects with MCI, and 29 cognitive healthy control subjects matched for demographic characteristics, hypertensive condition, smoking habits, and laboratory parameters were enrolled. Each subject underwent clinical and cognitive examination, a structural brain imaging study, electrocardiogram (ECG), 24-h ECG recording, 24-h blood pressure monitoring, and echocardiogram. Detection and characterization of QT dispersion, SMI and VA were performed. RESULTS: The three groups were comparable regarding demographic and basal cardiovascular characteristics: notwithstanding this, SMI episodes were observed only in AD and MCI patients (19 and 14, respectively). A significantly greater prevalence of repetitive ventricular premature beats was observed in AD (mean 8.56+/-13.1) and in MCI (1.8+/-7.2) vs. control (0.7+/-1.7). The QTD, the ischaemic burden and the number of repetitive ventricular beats revealed to be significantly related. CONCLUSIONS: Increased prevalence of SMI and potentially ominous VA were found in AD and, to a lesser extent, in MCI. SMI and repetitive VA were significantly related with QTD. These findings could be related to an increased risk of sudden cardiac death in AD and MCI patients.     

Fever is associated with third ventricular shift after intracerebral hemorrhage: pathophysiologic implications

BACKGROUND: Studies have shown the detrimental effect of increased temperature on brain injury. Fever is common after intracerebral hemorrhage (ICH). The term 'central fever' is often used when no cause is identified. AIM: The aim of the study was to determine the correlation of fever with third ventricular shift in 61 patients with ICH and hypothesize about the mechanism of fever. SETTING: Neurointensive Care Unit. DESIGN: Prospective observational study. MATERIALS AND METHODS: From August 1999 to April 2000, data from 61 patients with ICH were prospectively collected including maximum temperature (Tmax) and fever (T> 37.5 degrees C) at 24, 48, 72 and 96 hours, ICH volume, and third ventricular shift. Outcome measures included discharge mortality, 3-month National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Barthel Index (BI). STATISTICAL ANALYSIS: Spearman correlation coefficient, Mann-Whitney test, and logistic regression were used to assess relationships. RESULTS: Fifty-six per cent of patients had fever in the first 24 hours and 53% for at least two consecutive days. There was a correlation between ICH volume and Tmax at 24 hours (P =0.04) and 72 hours (P =0.03) and fever at 24 hours (P =0.039) and 72 hours (P =0.036). Tmax at 72 hours correlated with third ventricular shift (P =0.01). Those with shift were more likely to have fever within the first 72 hours (P =0.049) and worse outcome. Fever at 72 hours was associated with a higher discharge mortality (P =0.046) and trend of a worse 3-month NIHSS score (P =0.06). CONCLUSION: Fever is common after ICH and correlates with ICH volume and third ventricular shift suggesting a role of hypothalamic compression in "central fever." There was a trend towards a worse outcome with fever.     

RAGE基因多态性与高血压左室肥厚、血清esRAGE水平的相关性研究

目的探讨晚期糖基化终末产物受体(RAGE)基因Gly82Ser多态性与EH-LVH患者及其血清内源性分泌型RAGE(esRAGE)水平的相关性。方法应用聚合酶链反应-限制性片段多态性(PCR-RLFP)的方法,检测94例EH患者(其中38例伴LVH)及50例对照组RAGE基因Gly82Ser多态性,同时采用ELISA法测定血清esRAGE水平。结果与正常对照组相比,EH组基因型频率和等位基因频率差异无统计学意义(P>0.05);EH-LVH组RAGE基因Gly82Ser位点的GS基因型频率和82Ser等位基因频率明显增高,差异有统计学意义(P<0.05);EH-LVH和EH组Gly82Ser SS基因型血清es-RAGE水平与对照组相比差异显著(P<0.05)。结论 RAGE基因Gly82Ser多态性与EH的发生发展无关;EH-LVH患者RAGE基因Gly82Ser GS基因型和82Ser等位基因增多,提示82Ser等位基因可能是EH-LVH发病的易感基因;RAGE基因Gly82Ser多态性与血清esRAGE水平显著相关。     

Effect of Premature Ventricular Contractions on Middle Cerebral Artery Blood Flow Velocity

The effect of premature ventricular contractions on blood flow velocity in the middle cerebral artery was studied by transcranial Doppler ultrasonography in 1 0 patients. Velocity during three ectopic beats for each patient was lower than that during the preceding and the following beat in every recording. The decrease in peak velocity was 30.7 ± 12.4% and 37.1 ± 13.3% (mean ± standard deviation) compared to the preceding and following beat, respectively. This variation was significantly larger (p < 0.0001) than the spontaneous change observed during sinus rhythm, 2. 7 ± 2.2% in patients with premature ventricular contractions and 3.5 ± 3.2% in control subjects. Similar results were obtained for both mean and diastolic blood flow velocities. Systolic-diastolic ratios were similar for premature ventricular contractions, beats preceding or following premature ventricular contractions, and sinus rhythm beats. Transcranial Doppler ultrasound appears to be an excellent technique for analyzing the effects of cardiac arrhythmias on the cerebral circulation.