大脑半球梗塞患者的心脏自主神经活性昼夜节律变化

目的 了解脑梗塞对心脏自主神经活性昼夜节律的影响及其意义。方法 利用动态心电图技术记录６６例急性脑梗塞患者和３９例对照的连续２４ｈ心电信号,分析比较每小时、白天清醒期和夜间睡眠期的心率变异性变化。结果 对照组心率变异性有明显的昼夜节律变化。其ＴＰ、ＨＦ、ＰＮＮ５０和ＲＭＳＳＤ清醒期明显低于睡眠期,ＬＦ／ＨＦ清醒期高于睡眠期;左侧和右侧大脑半球梗塞患者心率变异性各指标清醒期和睡眠期无明显昼夜节律变化。结论 大脑半球梗塞患者急性期的心脏自主神经活性昼夜节律变化消失。     

围绝经期妇女更年期症状与心率变异性的关系

目的 探讨围绝经期妇女更年期症状与心率变异性的关系。方法 ５６例围绝经期妇女依血清Ｅ２，ＦＳＨ水平分为低激素组和对照组，进行２４小时动态心电图检查及心率变异性分析，并与Ｋｕｐｐｅｒｍａｎ评分比较。结果 与对照组相比，低激素组在症状评分，ＳＤＡＮＮ，日间ＨＦ，ＬＦ／ＨＦ，在ＳＤＮＮ，ＲＭＳＳＤ，２４小时ＨＦ，睡眠ＨＦ差异均有显著性，在三角指数差异无显著性。ＳＤＮＮ，ＳＤＡＮＮ，２４小时ＨＦ和２４小时     

心率变异性频谱分析诊断糖尿病心脏自主神经病变

目的早期发现糖尿病自主神经病变。方法应用２４小时动态心电图心率变异性频谱分析检查了５６例糖尿病合并或不合并心脏自主神经病变患者。结果常规检查有心脏自主神经病变组（ＤＭ２组）入睡后高频（ＨＦ）成份明显＜无自主神经病变组（ＤＭ１组）＜正常对照组（Ｐ＜０．００１），而卧位及入睡后低频（ＬＦ）成份又高于对照组（Ｐ＝０．０００１）。从卧位到立位状态ＬＦ／ＨＦ比值上升幅度在ＤＭ１组小于对照组。结论心率变异性频谱分析是一种敏感的诊断糖尿病自主神经病变的方法     

慢性充血性心力衰竭患者心率变异性初步分析

对４８例正常人、５２例充血性心力衰竭（ＣＨＦ）患者的心率变异性（ＨＲＶ）进行分析，发现ＣＨＦ患者２４小时ＳＤＡＮＮ、ｒＭＳＳＤ及ｐＮＮ５０等时域指标明显低于正常人；ＬＦ、ＭＦ、ＨＦ和ＴＰ等频域指标也明显低于正常人，ＬＦ／ＨＦ比值略高于正常人。揭示ＣＨＦ患者存在自主神经功能损害，交感神经相对占优势     

脑梗死患者心脏自主神经活性变化与心电图异常的关系

目的 探讨不同部位脑梗死与心脏自主神经活性变化和ECG异常的关系。方法 检测156例急性大脑半球梗死患者和206名正常对照组心率变异性和标准12导联ECG，分析不同部位大脑半球梗死对心脏自主神经活性和ECG的影响。结果 与对照组比较，仅右侧岛叶梗死组心率变异性相邻心搏间期差的均方根(RMSSD)、相邻心搏间期差大于50ms的心搏问期数占心搏问期总数的百分比(PNN50)和高频功率谱(HF)明显降低，心脏副交感神经活性降低；低频功率谱(LF)与高频功率谱的比值(LF／HF)明显升高，心脏交感神经活性增强；腔隙性脑梗死组、非岛叶梗死组和左侧岛叶梗死组的心率变异性各项指标均无明显差异；右侧岛叶梗死患者快速心律失常和QTc延长发生率显著增加．左侧岛叶脑梗死患者srr段上升或下降显著增加；快速心律失常组RMSSD、PNN50和HF明显低于非快速心律失常组．LF／HF则明显高于非快速心律失常组。结论 影响脑梗死患者心脏自主神经活性和ECG的主要病变部位为岛叶。     

急性脑梗死患者的动态心电图异常

目的 了解急性脑梗死患者心电图复极改变和心律失常情况及其与岛叶病变的关系。方法 检测７４例急性脑梗死患者和３９例对照的２４小时动态心电图，分析其心电图复极改变和心律失常。结果 右侧大脑半球岛叶梗死患者急性期室上性快速心律失常和房颤发生率明显增高；左侧大脑半球岛叶梗死患者急性期心电图ＳＴ段降低发生率明显增高。结论 左侧和右侧大脑半球梗死对心脏的影响不同，岛叶病变在其中起着主要作用。     

脑源性心脏自主神经功能紊乱的干预研究

目的观察电刺激脑梗塞患者小脑顶核的心脏自主神经活性变化。方法利用动态心电图，比较脑梗塞患者和对照组的心率变异性变化。将患者随机分成电刺激小脑顶核组和非刺激组，观察两组的心率变异性变化。结果脑梗塞患者的心率变异性降低，与对照组比较差异明显。刺激小脑顶核使患者心率变异性增加，与非刺激组比差异明显。结论电刺激小脑顶核可改善脑梗塞患者心脏自主神经功能紊乱。     

急性脑梗塞血清可溶性血管细胞粘附分子的变化及意义

为了解急性脑梗塞血清可溶性血管细胞粘附分子（ｓＶＣＡＭ－１）的变化及临床意义，采用双抗体夹心ＥＬＩＳＡ法测定了８９例脑梗塞患者血清ｓＶＣＡＭ－１，并与４３例脑出血和３０例正常人对照比较，结果显示，脑梗塞患者２４小时内血清ｓＶＣＡＭ－１水平明显高于脑出血和正常对照组（Ｐ＜０．０１）。大梗塞灶组血清ｓＶＣＡＭ－１水平明显高于中梗塞灶组和小梗塞灶组。脑梗塞患者血清ｓＶＣＡＭ－１水平在脑梗塞发生２４小时至７天呈上升趋势，７～１４天呈下降趋势，但第１４天ｓＶＩＣＡＭ－１水平仍高于脑出血组和正常对照组。脑梗塞后并发感染者在１４天内血清ｓＶＣＡＭ－１水平明显高于无并发感染者。研究结果提示，ｓＶＣＡＭ－１与急性脑梗塞密切相关，在脑梗塞中深入研究ｓＶＣＡＭ－１有重要的临床应用价值。     

急性心肌梗塞患者心率变异性与病死率关系的探讨

对８０例急性心肌梗塞、２０例不稳定型心绞痛患者和２０例无心脏病的对照组进行了２４小时动态心电图记录。急性心肌梗塞患者自入院后立即测肌酸磷酸激酶（ＣＰＫ），３天后进行彩色多普勒检查。结果提示：急性心肌梗塞患者２４小时平均心率高于心绞痛组和正常对照组，而心率变异性明显低于以上两组。心率变异性同急性心肌梗塞患者的梗塞面积大小及左心室舒张末内径是负相关。本文８０例急性心肌梗塞患者死亡９例。其死亡患者的心率变异性为３３．６±６ｍｓ，均＜５０ｍｓ，明显低于急性心肌梗塞的幸存者。说明心率变异性可以作为观察急性心肌梗塞患者病情的一个指标，尤其是心率变异性＜５０ｍｓ可以作为判定预后不良的一个重要危险因素。     

心率变异性与高血压左室重构关系的研究

目的：心率变异性（ＨＲＶ）分析是反映心脏自主神经活动的一项无创性指标。方法：研究ＨＲＶ在高血压左室重构中的作用,应用ＨＲＶ时域与频域分析法,检测与分析７０例高血压病（ＥＨ）男性患者２４小时ＲＲ间期标准差（ＳＤＮＮ）、心率变异指数（ＨＲＶＩ）及心率功率谱密度（ＰＳＤ）;并采用超声心动图测定相对室壁厚度（ＲＷＴ）与左室重量指数（ＬＶＭＩ）对患者进行左室构型分类。３０例健康男性被同期检测,以作对照。结果：７０ 例ＥＨ 患者被分为正常构型（ＲＷＴ 与ＬＶＭＩ均正常）,向心性重构（ＲＷＴ 增加,但ＬＶＭＩ正常）,向心性肥厚（ＲＷＴ与ＬＶＭＩ均增加）及离心性肥厚（ＲＷＴ正常,但ＬＶＭＩ增加）四个左室构型组。四组患者ＳＤＮＮ、ＨＲＶＩ、ＰＳＤ的低频（ＬＦ）峰值及其与高频（ＨＦ）峰值之比（ＬＦ／ＨＦ）均较正常人减低,而ＰＳＤ的ＨＦ峰值却均较正常人增高,该ＨＲＶ 变化特征的显著性依上述左室构型顺序呈现进行性增强。结论：交感与副交感神经的双重损害参与了高血压的左室重构机制,且其损害程度可能伴随左室重构过程的进行而加重     

不同部位脑梗死患者心率变异性与血浆肌酸激酶同工酶活性变化

目的 了解不同部位脑梗死对心脏自主神经活性和心脏的影响。方法 选择130例不同部位急性大脑半球梗死患者及130例年龄匹配的健康体检者(对照组),检测心率变异性(HRV)和血浆肌酸激酶同工酶(CK-MB)活性,分析其.HRV和CK-MB活性变化的关系。结果 右侧岛叶梗死患者HRV指标高频功率谱(HF)、均方根、相邻RR间期差≥50 ms的心搏数占总窦性心搏数的百分比明显下降和低频功率谱(LF)/HF明显增高;CK-MB活性升高主要见于岛叶梗死患者,双侧无明显差异;CK-MB活性升高者LF和LF/HF高于CK-MB活性正常者,HF明显低于CK-MB活性正常者;CK-MB活性升高者病死率明显升高。结论 大脑半球梗死患者时心脏的影响主要与岛叶病变有关。     

急性脑出血患者24小时心率变异性变化与动态心电图异常

目的：了解急性脑出血对心脏自主神经活性改变，心电图复极改变和心律失常的影响。方法：检测61例急性大脑半球壳核和额顶颞叶出血患者和39例对照的24h动态心电图，分析其心率变异性变化，心电图复极改变和心律失常。结果：右侧壳核和额顶颞叶出血患者急性期室上性快速心律失常和心房颤动发生率明显增高，左侧壳核和额顶颞叶出血患者急性期心电图ST段降低发生率明显增高，右侧壳核和额顶颞叶出血组心率变异性指标HF，RMSSD，PNN50明显下降和LF／HF明显增高，伴室上性快速心律失常者LF／HF高于无室上性快速心律失常者，HF明显低于无室上性快速心律失常者。结论：左侧和右侧大脑半球出血对心脏的影响不高，岛叶病变在其中起着主要作用。     

Changes of heart rate variability during ventilator weaning

STUDY OBJECTIVES: Despite the recognition that ventilator weaning is associated with a change in autonomic nervous system activity, there has not been any report concerning the change of heart rate variability (HRV), a reliable method to detect autonomic nervous system activity, in patients during weaning. The aim of this study was to investigate the change of autonomic nervous system activity during ventilator weaning by HRV analysis. DESIGN: Prospective study. SETTING: A 16-bed medical ICU of a tertiary university hospital. PATIENTS: Twenty-four patients receiving mechanical ventilation were included. Twelve patients with successful extubation after a spontaneous breathing trial (SBT) [T-piece trial] were classified as the success group; otherwise, the patients were placed in the failure group. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Variables, including the total power (TP), and the high-frequency (HF) and low-frequency (LF) components of HRV, were measured in three phases: assist/control mandatory ventilation, pressure support ventilation (PSV), and SBT. While shifting from PSV to SBT, the HRV components decreased significantly in the failure group (TP, p = 0.025; LF, p = 0.007; HF, p = 0.031), but not in the success group. CONCLUSIONS: By HRV analysis, reduced HRV and vagal withdrawal of the autonomic nervous system activity are the main changes in patients with weaning failure.     

Inhomogeneous derangement of cardiac autonomic nerve control in diabetic rats.

The present study compared autonomic nervous function in Kob [Spontaneously Diabetic, Bio-Breeding (BB)] rats with control Wistar rats to determine the development of cardiac neuropathy in diabetic rats. Telemetric ECG signals were obtained from an ECG radio-transmitter placed in a dorsal subcutaneous pouch of male Kob and Wistar rats for 30min every 6h at a sample rate of 5kHz. Heart rate (HR) and HR variability (HRV) were analyzed in each group by power spectrograms obtained by a fast Fourier transform algorithm. RR interval, total power (TP), low frequency (LF) power (0.04-0.67 Hz), high frequency (HF) power (0.79-1.48 Hz) and LF/HF ratio were also measured. The Kob rats had lower HRV than the control Wistar rats; HR, TP, and HF power, but not the LF/HF ratio, in the Kob rats were significantly lower than those of the control rats (p<0.001). However, in the Kob rats the response of these parameters to a muscarinic antagonist (atropine: 2mg/kg) was left intact, but their response to a beta-adrenergic antagonist (propranolol: 4mg/kg) was impeded. Autonomic nervous control of HR in spontaneously diabetic rats was inhomogeneously deranged in terms of the balance in sympathetic and parasympathetic tone, not only in the baseline condition, but also in the regulatory systems, including postsynaptic receptor function.     

哌仑西平对兔急性心肌缺血心室颤动阈值的影响及其机制

目的 :观察小剂量哌仑西平对兔急性心肌缺血心室颤动阈值的影响。探讨自主神经作用及其机制。方法 :建立兔急性心肌缺血模型。采用颈迷走神经切断术、心脏交感神经化学切割技术建立不同自主神经支配的心脏模型。以心率变异频域指标测定心脏自主神经活性 ,应用心电生理研究方法测定急性心肌缺血心室颤动阈值 （VFT）。结果 :兔急性心肌缺血时 ,哌仑西平预处理组较单纯结扎组频域指标 VL F,L F与 L F/ HF降低 ,HF增高 ;电生理指标VFT增高。颈迷走神经切断后 ,急性心肌缺血时 ,哌仑西平预处理组较单纯结扎组频域指标 VL F,L F,L F/ HF降低 ,HF无显著变化 ,VFT增加。心脏交感神经化学切除后 ,急性心肌缺血时 ,哌仑西平预处理组较单纯结扎组频域指标 VL F,L F,L F/ HF降低 ,HF增加 ,VFT增大。结论 :小剂量哌仑西平预处理能改善兔急性心肌缺血时的心电生理不稳定状态。此作用与直接降低心脏交感神经活性及直接提高心脏迷走神经活性有关     

Changes in autonomic nervous activity prior to spontaneous coronary spasm in patients with variant angina

Although the autonomic nervous system has been implicated in the genesis of coronary spasm, the precise mechanism by which it serves as the trigger of coronary spasm remains unclear. The aim of this study was to investigate changes in autonomic nervous activity associated with ischemic episodes in patients with variant angina (VA). Heart rate variability (HRV) on Holter monitoring was analyzed during 17 ischemic episodes in 11 patients with VA. The parameters of HRV were measured during a 2-min period at various time intervals prior to the onset of ST-segment elevation. The low frequency (LF) and high frequency (HF) components of the HRV, LF/HF ratio, mean RR interval, and the coefficient of the RR interval variation (CV) were calculated for each time interval. Both the HF and the CV increased significantly in the 2 min prior to the onset of ST-segment elevation, suggesting heightened vagal activity. The LF/HF ratio, a measure of cardiac sympatho-vagal balance, did not change. The LF, a measure of sympathetic activity with vagal modulation, also did not change. The RR interval decreased significantly in the 2 min prior to the onset of ST-segment elevation. These results suggest that enhancement of both the vagal and the sympathetic nervous activity plays an important role in the initiation of coronary spasm.     

Hyperthyroidism is characterized by both increased sympathetic and decreased vagal modulation of heart rate: evidence from spectral analysis of heart rate variability

OBJECTIVE: The clinical manifestations of hyperthyroidism resemble those of the hyperadrenergic state. This study was designed to evaluate the impact of hyperthyroidism on the autonomic nervous system (ANS) and to investigate the relationship between serum thyroid hormone concentrations and parameters of spectral heart rate variability (HRV) analysis in hyperthyroidism. DESIGN AND PATIENTS: Thirty-two hyperthyroid Graves' disease patients (mean age 31 years) and 32 sex-, age-, and body mass index (BMI)-matched normal control subjects were recruited to receive one-channel electrocardiogram (ECG) recording. MEASUREMENTS: The cardiac autonomic nervous function was evaluated by the spectral analysis of HRV, which indicates the autonomic modulation of the sinus node. The correlation coefficients between serum thyroid hormone concentrations and parameters of the spectral HRV analysis were also computed. RESULTS: The hyperthyroid patients revealed significant differences (P < 0.001) compared with the controls in the following HRV parameters: a decrease in total power (TP), very low frequency power (VLF), low frequency power (LF), high frequency power (HF), and HF in normalized units (HF%); and an increase in LF in normalized units (LF%) and in the ratio of LF to HF (LF/HF). After correction of hyperthyroidism in 28 patients, all of the above parameters were restored to levels comparable to those of the controls. In addition, serum thyroid hormone concentrations showed significant correlations with spectral HRV parameters. CONCLUSIONS: Hyperthyroidism is in a sympathovagal imbalanced state, characterized by both increased sympathetic and decreased vagal modulation of the heart rate. These autonomic dysfunctions can be detected simultaneously by spectral analysis of HRV, and the spectral HRV parameters could reflect the disease severity in hyperthyroid patients.     

Dysfunction of pre- and post-operative cardiac autonomic nervous system in elderly patients with diabetes mellitus

The pre- and post-operative cardiac autonomic nervous functions were compared in elderly, non-cardiac surgery patients with diabetes mellitus (DM) and without diabetes mellitus (NDM). A group of 30 unpremedicated elderly patients scheduled to undergo elective non-cardiac surgery were studied, including 15 DM patients and 15 NDM patients. Each component of heart rate variability (HRV) analysis in the frequency domain was monitored with Holter during the nights of the day before and on 1st and 2nd day after operation. After surgery, total power (TP), high frequency (HF), low frequency (LF) and very low frequency (VLF) significantly decreased as compared to the baseline values before operation in both groups (p < 0.05). The LF/HF ratio was significantly changed in DM group but did not change in NDM group. On the 2nd postoperative day, TP, HF, LF and VLF in DM group were further decreased as compared to those on the 1st postoperative day and were significantly lower than those in NDM group (p < 0.01 or 0.05), but these indices in NDM group did not show significant decreases. Surgery induced the cardiac autonomic nervous dysfunction in elderly patients not only with DM but also without diabetes. On the 2nd postoperative day, the disturbances of cardiac autonomic nervous activity were more sever in DM patients, compared to the 1st postoperative day, but was not significantly more sever than in the NDM patients.     

实验性心肌缺血大鼠心脏自主神经活性的动态变化及意义

采用心率变异（ＨＲＶ）时域及频域指标分析急性心肌缺血２４ｈ大鼠心脏自主神经功能的变化以探讨其意义。将实验动物分成三组，即正常对照组（２０只）、假手术组（２０只）与心肌缺血组（４８只），并运用动态心电图记录２４ｈ心电信号变化。结果显示：与假手术组及正常对照组分别比较，心肌缺血组正常窦性心律ＲＲ间期标准差（ＳＤＮＮ）下降（２８．９±９．４ｍｓｖｓ３４．４±１３．７ｍｓ或３５．１±１４．３ｍｓ，Ｐ均＜０．０５），低频（ＬＦ）及低频与高频的比值（ＬＦ／ＨＦ）明显增加（１８９．４±３６．５ｍｓ２／Ｈｚｖｓ５７．３±１７．８ｍｓ２／Ｈｚ或５１．８±１８．６ｍｓ２／Ｈｚ；３．８５±０．９１ｖｓ１．７６±０．６３或１．６８±０．５７，Ｐ均＜０．０１）；２４ｈ心率功率谱示心肌缺血组ＬＦ及ＬＦ／ＨＦ波动幅度较假手术组及正常对照组增高，缺血大鼠ＬＦ与ＬＦ／ＨＦ在缺血后０～３ｈ（２６７．５±１２．４ｍｓ２／Ｈｚ、４．３３±１．０８）及９～１２ｈ（２４４．７±１３．９ｍｓ２／Ｈｚ、３．９６±０．９８）期间增高显著，而在缺血后５～７ｈ（１４９．２±８．７ｍｓ２／Ｈｚ、２．０５±０．４２）内则相对较低。结果表明大鼠心肌缺血后ＨＲＶ降低主?