冠心病和心率变异性

心率变异性(Heart rate variability,HRV)是指心率快慢的差异性,是逐个心动周期的细微变化。HRV的实质反映了交感一副交感神经张力及其平衡,其发生的基础是自主神经对心率的调节作用。HRV在正常人有明显的昼夜节律变化。     

慢性肾衰患者心率变异性改变

目的　通过心率变异性 (HRV)变化测定 ,探讨慢性肾功能衰竭 (CRF)患者的自主神经活动状况。方法　用2 4小时动态心电图分析系统 ,对 2 0例健康者 ,77例CRF患者 (其中 30例氮质血症 ,4 7例尿毒症 )心率变异性的时域指标进行对比研究。结果　CRF患者心率变异性的测定结果为 :SDNN 85 .2 8± 19.96 ,SDANN 75 .5 5± 2 2 .4 7,r-MSSD19.2 2± 11.82 ,PNN50 6 .7± 14 .79,各项指标均明显低于健康者 (P <0 .0 1)。氮质血症期与尿毒症期心率变异性无明显差别。结论　通过HRV时域分析发现 ,CRF患者有自主神经调节功能紊乱。CRF氮质血症期患者已出现HRV下降 ,提示CRF患者早期就存在自主神经功能损害。     

二种钙拮抗剂对冠心病患者心率变异性的影响

观察了50例冠心病患者分别服用合心爽(60mg,tid,一周),和拜心通(30mg,Bid,一周)后心率变异性(HRV)的变化。结果:冠心病患者24h HRV频域指标中的总功率谱面积(TP)、高频成份的标准化单位(HFn)及低频成份标准化单位(LFn)的各时段测值与健康对照组比较有显著差异;服用合心爽后,TP、HFn、LFn的各时段测值均较用药前显著改善,服用拜心通后则无相应改善。提示合心爽能显著改善冠心病患者的心脏自主神经功能异常,拜心通无明显影响。     

脑梗塞患者心率变异性及其意义初探

以24小时全体心搏心率/R—R平均值标准差(SD)即时域法研究56例脑梗塞患者及41例健康对照者的心率变异性(HRV),并按脑梗塞侧别及病情严重性分为左、右侧及轻、中、重数个亚组进行研究。结果发现,脑梗塞组HRV显著低于对照组(P<0.001),右侧半球脑梗塞HRV显著低于左侧半球脑梗塞(P<0.01),轻、中、重不同严重程度脑梗塞HRV之间无显著差异。脑梗塞组有2例病人于半年内死于心源性猝死,其HRV均<50ms。本文对脑梗塞患者HRV意义进行了探讨。     

心率变异性在更年期综合征患者中的意义

目的 分析更年期患者的心率变异特点，研究更年期综合征（climacteric syndrome,CS)患者与自主神经功能之间的关系。方法 对65例更年期患者及100例健康女生做24h长程心率变异（HRV）比较，分析CS患者HRV的变化。结果 CS患者与健康女性相比较，其迷走神经活性明显增强，交感神经活性相对降低。结论 CS患者与迷走神经活性增强有密切的关系。     

冠心病和糖尿病人心率变异性非线性动力学初探

研究了正常人以及冠心病单支病变,多支病变,糖尿病伴植物神经性病变这些已被证实在心率异性时域和频域上有明显变化的患者在非线性动力学上表现,选用的指标是散点图几项量化指标,测试熵和关联维数,研究表明：（1）正常人非线性参数中存在明显的昼夜变化,冠脉病人 变化程度减低,而糖尿病患者无昼夜变化,（2）根据冠脉病人和糖尿病人生理上都具有植物性神经紊乱的,现象,可以知道植物性神经是影响心脏非线性运动的一个重要因素;（3）正常人,冠脉病患者的轻重程度,糖尿病人的非线性参数;之间都存在比较明显的区别,提示可以将这些非线性参数应用于临床。     

2型糖尿病合并高血压和冠心病患者心率变异性分析

目的：探讨糖尿病合并高血压和冠心病患者心率变异性的临床意义。方法：选择佛山市南海区人民医院2型糖尿病患者105例,分为单纯糖尿病组、合并高血压组和合并冠心病组,每组35例,同时选择健康体检者35例作为对照组。所有研究对象进行动态心电图检查,分析各组心率变异性,包括24 h正常RR间期的标准差（SDNN）,每5分钟平均RR间期的标准差（SDANN）,每5分钟正常心动周期标准差的平均数（ASDNN）,比较各组心率变异性降低发生率和心律失常发生率。结果：3组患者组的SDNN、SDANN、ASDNN较对照组明显降低（P<0.05）;与单纯糖尿病组比较,合并高血压组和合并冠心病组SDNN、SDANN、ASDNN更低（P<0.05）;与合并高血压组比较,合并冠心病组SDNN、SDANN、ASDNN更低（P<0.05）。与对照组比较,3组患者组心率变异性中度以上降低的发生率及心律失常发生率明显增高（P<0.05）;与单纯糖尿病组比较,合并高血压组和合并冠心病组患者上述发生率较单纯糖尿病组增高（P<0.05）;合并冠心病组上述发生率高于合并高血压组（P<0.05）。...     

儿童焦虑症的心率变异性频谱分析

目的:通过对焦虑症患儿与正常儿童心率变异性(HRV)的比较,探索焦虑症患儿心脏自主神经功能的特点。方法:选择34例焦虑症患儿与30名正常儿童,使用汉密顿焦虑量表(HAMA)进行评估,应用24小时动态心电图记录仪测定HRV并进行比较。结果:焦虑症患儿SDNN、SDANN、RMSSD与PNN50均低于正常对照组(P0.05);焦虑症患儿LF/HF高于正常对照(P0.05),焦虑症患儿HAMA总分与SDNN呈负相关(r=-0.31,P0.05),躯体性焦虑因子分与LF呈正相关(r=0.35,P0.05),精神性焦虑因子分与PNN50呈负相关。结论:儿童焦虑症患者在静息状态下交感神经功能亢进,迷走神经水平降低,以及交感神经与迷走神经功能均衡性失调,并与焦虑症状相关。     

低氧与心率变异性研究进展

高原或运动等生理性低氧或/和临床心血管、呼吸及代谢等疾病病理性缺氧均可改变机体自主神经调节功能,从而导致心率变异性(HRV)变化。HRV对机体功能状态评定、多种疾病的诊断、预后及疗效评价具有重要价值。本综述简要介绍近年来有关低氧与HRV的研究进展。     

冠心病患者心率变异性指标与冠状动脉病变程度的关系

目的:探讨心率变异性指标与冠心病患者冠脉病变程度的关系。方法:选取冠心病患者84例（观察组）,同时选取健康志愿者90例作为对照组,均给予24 h动态心电图监测。结果:观察组NN间期的标准差（SDNN）、RR间期的均值标准差（SDANN）、相邻RR间期差值的均方根（RMSSD）、相邻RR间期差值>50 ms的心搏数所占百分比（PMN50）和高频功率（HF）分别为（95.54±20.12） ms、（94.48±21.15） ms、（29.84±10.06） ms、（7.46±2.31）%和（0.85±0.20） Hz,明显低于对照组（P<0.05）,而低频功率（LF）为（137.74±21.16） Hz,明显高于对照组（P<0.05）;冠状动脉病变≥3支患者SDNN、SDANN、RMSSD、PMN50和HF分别为（84.31±19.64） ms、（89.42±18.82） ms、（23.38±7.15） ms、（5.40±1.90）%和（0.70±0.21） Hz,明显低于冠状动脉病变数为1支和2支患者（P<0.05）,而LF为（150.54±21.15） Hz,明显高于冠状动脉病变数为1支和2支患者（P<0.05）;观察组男女患者SDNN、SDANN、RMSSD、PMN50、HF和LF比较差异无统计学意义（P>0.05）;Gensini评分与SDNN、SDANN、RMSSD、PMN50、HF呈负相关（r=-0.511、-0.487、-0.543、-0.512和-0.507, P<0.05）,与LF呈正相关（r=0.577, P<0.05）。结论:动态心电图在冠心病患者冠脉病变程度评价中有一定应用价值,其心率变异性指标与冠状动脉病变程度有一定关系。     

岛叶的功能及对心率变异性的影响

心率变异性作为判断心脏自主神经状态的无创性指标常被用来定量分析自主神经的功能状态，其时域及频域降低与恶性心律失常、心功能不全，乃至心源性猝死等有关。人类的岛叶是控制交感神经和副交感神经介导的心血管调节最重要的皮层区域，多数学者在临床实践中发现，岛叶病变会导致心血管功能紊乱及自主神经功能状态的变化，因此岛叶与心脏功能之间的联系倍受重视。     

Nonlinear analysis of heart rate variability of healthy subjects and patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is one of the causes of mortality worldwide with an increasing prevalence. Heart rate variability (HRV) reflects the regulation mechanism of the cardiac activity by the autonomic nervous system. The assessment of HRV by using nonlinear methods is more sensitive for the detection of complexity when compared to linear methods. This study aims to get information about the autonomic dysfunction occurred in patients with COPD by analysing the complexity of HRV. Electrocardiogram signals recorded from healthy subjects, patients with moderate COPD and severe COPD (eight subjects per group) were analysed. The HRV signals were acquired from ECG signals. Signals were reconstructed in the phase space and largest Lyapunov exponent (LLE), correlation dimension, Hurst exponent and approximate entropy (ApEn) values were calculated. It has seen that for the patients with COPD LLE, correlation dimension, Hurst exponent and ApEn values were less than control group. According to this, HRV complexity decreases in the presence of COPD. However, there is no significant difference between COPD groups and the severity of COPD has no effect on the chaoticity of the system. The results revealed that autonomic dysfunction occurred in patients with COPD is associated with reduced HRV complexity.     

咖啡摄入前后心率变异性的对比研究

目的研究中等剂量咖啡摄入对青年受试者心率变异性的影响,明确咖啡对心脏自主神经活性的作用。方法无咖啡因摄入习惯的16名健康青年受试者(身高167 cm±7.2 cm、体重61.3 kg±6.3kg、年龄24.9岁±2.8岁)参与本项研究,在摄入含6 mg/kg咖啡因的咖啡饮品后,于8:40~10:45应用动态心电图记录仪(Holter)进行咖啡摄入前后心电信号的采集及心率(heart rate,HR)和心率变异性指标的分析。心率变异性指标包括R-R间期标准差(SDNN)、相邻R-R间期差值的均方根值(r MSSD)、相邻的R-R间期之差大于50 ms的心搏数占总心搏数的百分比(PNN50)、标化低频(normalized low frequency power,LFnorm)、标化高频(normalized high frequency power,HFnorm)、低频功率(low frequency,LF)与高频功率(high frequency,HF)的比值(LF/HF)。结果饮用咖啡后,心率、心率变异性指标均发生改变且具有统计学意义,HR、LFnorm和LF/HF分别降低了7.5%、17%和35%。r MSSD、PNN50和HFnorm分别提高了82%、80%和58%。其中HR及LF/HF随着时间的变化趋势最明显。HRV参数在饮用咖啡前后的差值ΔLF与ΔHF,ΔLF与ΔLF/HF均显著相关,相关系数为-0.980和0.903。结论中等剂量咖啡可引起心率变异性的改变和心率的降低,抑制交感神经活性,提高副交感神经活性。     

Heart rate variability in overactive bladder experimental model

Introduction

Two main pathophysiological concepts of overactive bladder (OAB) are postulated: the neurogenic and myogenic theories. Autonomic nervous system (ANS) dysfunction is also involved in OAB pathophysiology. The purpose of our study was to estimate ANS activity by heart rate variability (HRV) assessment in two OAB experimental models evoked by cyclophosphamide administration: acute (AOAB) and chronic (COAB) overactive ones.

Material and methods

In the AOAB model, an i.p. dose of cyclophosphamide was administered (200 mg/kg body weight) while the COAB model received 4 times the i.p. administration of cyclophosphamide (75 mg/kg body weight). In each subject, after urethane anaesthesia (1.2 g/kg body weight), 20-minute ECG recordings (PowerLab) were performed with subsequent HRV analysis.

Results

Most of the differences in time domain analysis parameters were insignificant, except those concerning SDNN and rMSSD (p < 0.05). In frequency analysis, a power decrease of all standard spectral components was revealed in both OAB groups. In AOAB, TP (1.43 ±1.21 vs. 7.92 ±6.22 in control; p < 0.05) and VLF (0.95 ±1.08 vs. 6.97 ±5.99 in control; p < 0.05) showed significant power decrease, whereas the COAB group was mostly characterized by LF (0.09 ±0.15 vs. 0.34 ±0.33 in control; p < 0.05) and HF (0.25 ±0.29 vs. 0.60 ±0.41 in control; p < 0.05) decrease.

Conclusions

The ANS disturbances, found as standard spectral parameter abnormalities, were demonstrated in both AOAB and COAB. When this finding is analysed, together with the lack of statistically significant differences in normalized nLF and nHF powers, the VLF changes seem to play an essential role, probably reflecting the progression in bladder inflammatory changes.     

Heart rate variability at rest and during mental stress in patients with coronary artery disease: Differences in patients with high and low depression scores

This study tested the hypothesis that coronary artery disease (CAD) patients with high depressed mood scores differ in sympatho-vagal balance during mental stress compared to patients with low depressed mood scores. Using electrocardiographic monitoring, heart variability data from spectral analysis and hemodynamic parameters were obtained prior to and during mental stress from 34 men and 7 women. A public speaking task was used as the mental stressor. Patients were grouped by a median split of their Minnesota Multiphasic Personality Inventory-Depression score. During mental stress, patients with higher depression scores had greater changes in peak heart rate (p > .05) and low frequency to high frequency power ratio (p > 0.05) than patients with lower scores suggesting a shift toward more sympathetic activity during mental stress. These findings may be related to the reported relation between depression and survival risk in patients with CAD. This study was supported by Grant 1-R01-HL-47477 from the National Heart, Lung and Blood Institute, General Clinical Research Center Grant RR00046 from the National Institutes of Health, and Cooperative Agreement CR817643 from the Environmental Protection Agency.     

利用Lorenz散点图分析高血压患者的运动心率变异信号

目的探讨高血压患者运动心率变异信号的非线性特征,为临床诊断高血压患者的心血管功能状况提供参考。方法以高血压患者作为研究对象,以健康者作为对照组,采集阶梯试验运动过程中两组人群的运动心电信号,提取其中包含的运动心率变异信号进行分析,运用散点图的定性和定量分析方法,将两组人群的散点图形状和散点图的6个参数进行对比。结果高血压患者与健康者的运动心率变异信号散点图在运动前后的表现差异明显,且高血压患者的各散点图参数数值较低。结论提示运动心率变异信号的散点图可用于高血压疾病患者的心血管系统功能损伤评测。     

真武汤加味对冠心病心力衰竭患者左心功能的影响

目的：评价真武汤加味对冠心病心力衰竭患者左心功能的影响。方法：100例冠心病心力衰竭患者随机分为治疗组和对照组,各50例。对照组用西医常规药物治疗,治疗组用西医常规药物加真武汤加味治疗,于入院当天和入院第90天行二维超声心动图测量,计算左心室舒张末内径、左心室收缩末内径和左室射血分数,并抽血检查血浆N端脑钠肽前体水平的变化。结果：与治疗前比较,两组的左心室舒张和收缩末内径均显著缩小（均P〈0．01）,左心室射血分数均明显增加（均P〈0．01）,血浆N端脑钠肽前体水平均显著降低（均P〈0．01）,用药后治疗组各指标改善明显优于对照组（均P〈0．011。结论：西医常规药物加真武汤加味治疗可以显著改善冠心病心力衰竭患者的左心功能和心室重构。