急性脑卒中患者心率变异性变化的临床意义

心率变异性(HRV)是反映自主神经对心脏调控的特异性定量指标,由于心血管活动中枢位于脑,故脑部病变必然引起植物神经张力改变.2003年2月～2004年12月,我们对脑卒中患者HRV变化进行了观察.现报告如下.     

脑卒中及其预后与心率变异性的关系

脑卒中及其预后与心率变异性的关系郑周玲（福州市第二医院心功能室３５０００７）关键词脑血管意外心率变异性近年来，心率变异性（ＨＲＶ）在国内外愈益引起人们的关注。动态心电图（Ｈｏｌｔｅｒ）作为一种定量、无创性检查可重复应用于临床，其中心率变异性可作为心脑...     

心率变异性的混沌特征与脑卒中患者猝死

心率变异性(HRV)可有效地反映心脏自主神经活性及其变化。本研究拟通过脑卒中患者。HRV混沌特征的分析．探讨其发生猝死与其HRV混沌特征变化之间的关系。     

心率变异性

心率变异性胡桃红综述宋有城，朱俊审校心率变异性（ＨｅａｒｔＲａｔｅＶａｒｉｏｂｉｌｉｔｙＨＲＶ分析是通过测量连续正常Ｐ－Ｐ间期变化的变异数，从而反映心率的变化程度。由于Ｐ－Ｐ间期难以准确检测，且一般情况下Ｐ－Ｐ间期＝Ｒ－Ｒ间期，故目前常用Ｒ－Ｒ间期来...     

Ⅱ型糖尿病病人血脂与心率变异性的关系

应用２４小时动态心电图变异性时域分析,检测２７例高血脂或正常血脂的Ⅱ型糖尿病病人,结果：甘油三酯（ＴＧ）,胆固醇（ＣＨＯ）,高密度脂蛋白（ＨＤＬ）、低密度脂蛋白（ＬＤＬ）对于ＨＲＶ无影响（Ｐ〉０．０５）结论：血脂对于Ⅱ型糖尿病病人心率变异性无影响。     

Ⅱ型糖尿病病人血脂与心率变异性的关系

应用24小时动态心电图心率变异性时域分析,检测27例高血脂或正常血脂的Ⅱ型糖尿病病人.结果甘油三酯(TG)、胆固醇(CHO)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)对于HRV无影响(P＞0.05)结论血脂对于Ⅱ型糖尿病病人心率变异性无影响.     

心肌梗死心率变异性与心律失常关系的探讨

通过对急性心肌梗死组室性心律失常的观测与正常对照组分析比较，结果提示心肌梗死组心率变异性明显低于对照组，合并心律失常者心率变异性明显低于无并发症的心肌梗死，心率变异性在预测心肌梗死后心血管事件发生方面有一定的价值。     

急性心肌梗死患者心率变异性与病死率的关系

心脏猝死 (ＳＣＤ)是急性心肌梗死 (ＡＭＩ)的重要死亡原因。近年来研究证实ＳＣＤ与心脏的自主神经活动有关。我科从1993年 8月～ 2 0 0 0年 5月对收入院的 3 6例ＡＭＩ患者进行了Ｈｏｌｔｅｒ监测 ,观察其心率变异 (ＨＲＶ)。1　资料与方法1.1　对象　①ＡＭＩ组 3 6例 ,男 2 2例 ,女 14例。年龄 43～ 74(平均 5 7.5 )岁。均符合ＷＨＯ( 1979)诊断标准。梗死部位 :广泛前壁 5例 ,前间壁 16例 ,下壁 13例 ,下壁、正后壁、右室壁 1例 ,下壁合并下后壁 1例。②对照组 2 2例 ,男 15例 ,女 7例 ,年龄 41～ 78(平均 5 5 .2 )岁 ,均为无器质性心…     

老年心率变异性时域分析及临床意义

目的 分析老年心率变异性(HRV)及其临床意义。方法 对无心血管系统疾病和糖尿病、甲亢病的老年健康体检者,进行24h动态心电图检查后实施心率变异性长程时域分析,与同期中、青年和老年前期健康体检者进行对比研究。结果 老年HRV各项指标的平均值为:SDNN(112.49±32.29)ms,SDANN-Index(107.75±84.04)ms,SDNN-Index(45.69±23.74)ms,RMSsD(35.45±31.56)ms,PNN50(10.70±17.74)ms。与中、青年和老年前期比较,心率变异性降低,SDNN差异有显著性,与年龄呈负相关。结论 老年心率变异性较中、青年和老年前期降低,SDNN随年龄增加逐渐下降。     

冠心病血清胰岛素浓度与心率变异性的变化及其关系

检测冠心病３４例，对照组３０例糖耐量前后血糖、胰岛素、Ｃ肽的变化，并测定２４小时动态心电图心率变异性（ＨＲＶ）。结果冠心病组空腹与服糖后胰岛素、Ｃ肽均明显升高，ＨＲＶ显著下降。进行血糖、胰岛素、Ｃ肽同ＨＲＶ相关分析，仅显示服糖后２小时胰岛素和胰岛素曲线下面积与ＨＲＶ呈负相关，ＨＲＶ≤１００ｍｓ的冠心病组显示更高的胰岛素水平，提示高胰岛素血症的交感神经兴奋作用可能是冠心病患者ＨＲＶ降低的原因之一。     

急性心肌梗塞患者心率变异性频域分析

心率变异性(HRV)分析是新近发展的一种反映自主神经对心脏控制的无创性检测指标,HRV降低者易发生心源性猝死。本文对21名正常人、42例急性心肌梗塞(AMI)患者进行HRV频域分析。结果表明,24小时RR间期变异标准差AMI患者明显低于正常人,频域分析结果正常人HRV功率谱密度(PSD)高频成分在白天和夜间有一定波动,日间相对较低,夜间睡眠时增加,而低频成分则变化不大。AMI患者,PSD与正常人相比,低频和高频成分均明显下降,而高频成分下降更为明显。这提示AMI患者支配心脏的迷走和交感神经均受损,以迷走神经受损更为严重。     

阵发性室上性心动过速射频消融术前后心率变异性的比较

目的探讨射频消融术(RFCA)后心率变异性(HRV)的改变.方法选择阵发性室上性心动过速患者51例,男27例,女24例,年龄25～48岁,平均(39.5±4.7)岁,其中左侧房室折返性心动过速23例,右侧房室折返性心动过速16例,房室结折返性心动过速12例.应用24h动态心电图观察心率变异性各时域指标(SDNN、SDANN、SDANN Index、RMSSD、PNN50)、频域指标(LFnu、HFnu).结果RFCA术前各指标值比对照组低,术后3d所有HRV的各项频域及时域指标均较RFCA前显著降低,而术后2个月各项指标虽仍较RFCA前降低,但差异无统计学意义.结论射频电流对心脏自主神经有一定的损伤,在术后2个月可基本恢复.     

PROGNOSTIC SIGNIFICANCE OF HEART RATE VARIABILITY IN CENTENARIANS

We studied the significance for further survival of heart rate variability and other variables in the very elderly. In 1992, we assessed activities of daily living, cognitive function, and nutritional status in 27 centenarians with no disease, in addition to the power of the heart rate variability in the ultralow, very low, low (LF), and high frequency (HF) bands. In 1996, we assessed survival in these centenarians; 17 had died and 10 were still living. Logistic regression analysis using backward elimination detected three factors, dementia, LF/HF, and age, that independently influenced mortality. Mortality risk increased with greater age in 1992, more severe dementia, or lower LF/HF. Sympathetic nerve activity, represented as LF/HF, may be associated with prognosis for survival in centenarians.     

HEART RATE VARIABILITY IN NORMOTENSIVE HEALTHY CHILDREN WITH AGING

Although the heart rate variability (HRV) values in adults decrease with aging, those in children show a variety of changes. The present study was designed to investigate the relationship between HRV and aging, physique and blood pressure in 70 healthy male school children, between 6 and 12 years of age. The subjects were divided into 3 age groups (6–7, 8–9 and 10–12 years) and 3 other groups according to physique (thin, under ?10%; normal, ?10–20% and obese, over 20% of obesity index). After recording a 24-h ambulatory electrocardiograph, HRV was determined spectrally, using 3 components: the total-frequency (TF) component (0.01 to 0.5 Hz), the low-frequency (LF) component (0.04 to 0.15 Hz), the high-frequency (HF) component (0.15 to 0.5 Hz) and also a two component ratio (LF/HF). The HRV values between the 3 age groups had a significant effect on TF, LF and LF/HF during the 24-h period, with the values increasing with age. The HRV values between the 3 physique groups had no significant effect. Therefore, changes in HRV in school children are affected by age and not physique. It is possible that the increase in HRV values with age is caused by the development of the autonomic nervous system.     

高血压病患者静息心率变化及临床意义

目的探讨高血压病患者的静息心率(RHR)变化及其临床意义。方法 120例高血压病患者分别测定其RHR、血糖、血脂,并作超声心动图检查,进行分组研究。结果高血压病组RHR(78.25±9.12)bpm,显著高于正常对照组(71.11±11.02)bpm(P<0.05),高血压病伴左室肥厚(LVH)RHR高于无LVH和正常对照组(P<0.05);高血压病伴高血糖、高血脂组RHR高于血糖、血脂正常和正常对照组(P<0.05)。结论RHR增加与高血压靶器官损害及高血压病伴代谢异常有明显的正相关。     

CHANGES IN AUTONOMIC NERVOUS ACTIVITY DURING COLONOSCOPY USING SPECTRAL ANALYSIS OF HEART RATE VARIABILITY

Background : Cardiac events are known to occur during colonoscopic procedures. In order to clarify the changes in autonomic nervous activity during colonoscopy, the circulatory dynamics were examined by spectrum analysis and by observing 1/f fluctuations of heart rate. Methods : The study group consisted of 39 subjects who underwent total colonoscopy (the TC group) and 46 subjects who underwent sigmoid colonoscopy (the SC group). Autonomic nervous function was assessed by analyzing the spectral analysis and 1/f fluctuation of the heart rate. Results : In the TC group, high‐frequency spectral power (HF power; 0.15–0.40 Hz), which reflects parasympathetic activity, was decreased during the early stages of the examination compared with that before endoscopy, and it significantly decreased during the late stages of the examination. There were no significant changes in the SC group. However, low‐frequency power (LF power; 0.04–0.15 Hz) and the LF/HF ratio both increased during the examination in both groups, suggesting increased sympathetic tone. The 1/f fluctuations were analyzed as the averaged regression lines and as that which related the log amplitude to the log frequency of spectra. The slopes of the regression line of 1/f fluctuations in the TC and SC groups had a tendency to approach zero during the colonoscopic procedure. Conclusion : These results indicate that the endoscopic procedure is stressful for patients. Total colonoscopy may more readily cause changes in the circulatory dynamics than does sigmoid colonoscopy. Increased blood pressure, arrhythmia and ST depression were also observed. These findings suggest that changes in autonomic nervous activity during colonoscopic procedure may cause cardiac accidents such as the appearance of fatal arrhythmia and acute myocardial infarction.     

肝硬化患者心血管反射和心率变异

目的：了解肝硬化患者的自主神经功能及其有病情严重程度的关系。方法：应用心血管反射试验和心率变异分析技术，检测了５５例肝硬化患者的自主神经功能。结果：６７％的肝硬化患者有一项以上心血管反射试验异常。肝硬化组心率变异值明显低于正常人。Ｃｈｉｌｄ积分与ｒ－ＭＳＳＤ、ＰＮＮ５０均呈负相关。结论：肝硬化患者自主神经功能异常的发生率较高，且与病情严重程度有关。