帕金森病患者颈部迷走神经横截面面积与心血管自主神经功能障碍的关系

目的 观察帕金森病(PD)患者颈部迷走神经横截面面积(CAS)变化,探讨其与心血管自主神经功能障碍的关系。方法 2019年10月—2022年10月河南省人民医院诊治PD患者45例为PD组,记录PD患者入院时帕金森病评定量表Ⅲ(UPDRS-Ⅲ)评分、Hoehn-Yahr(H-Y)分级。同期体检健康者45例为对照组。PD组于入院日、对照组于体检日采用PD自主神经症状量表(SCOPA-AUT)评估自主神经功能,记录SCOPA-AUT心血管评分;行颈部超声检查,测量左右侧颈部迷走神经CAS;行24 h动态心电图检查分析心率变异率,记录全部正常R-R间期标准差(SDNN)、全部相邻R-R间期差值的均方根(rMSSD)、高频功率(HF)、低频功率(LF)。比较2组性别、年龄、体质量指数、SCOPA-AUT总分、SCOPA-AUT心血管评分、颈部迷走神经CAS及SDNN、rMSSD、HF、LF;Pearson相关法分析PD患者左右侧颈部迷走神经CAS与PD病程、UPDRS-Ⅲ评分、H-Y分级、SCOPA-AUT评分、SCOPA-AUT心血管评分的相关性,右侧颈部迷走神经CAS与SDNN、rMSSD、...     

扩张型心肌病自主神经功能与心力衰竭的相关性

目的 探讨扩张型心肌病（DCM）自主神经功能受损状况。研究自主神经功能异常与心力衰竭的相关性。方法 采用临床病例对照，DCM组31例与正常人31例根据性别，年龄配对，运用动态心电图和计算机数据处理技术，结合心率变异（HRV）时域与频域分析，评价自主神经功能及平衡，超声心动图测量DCM患者左室射血分数（LVEF），左室短轴缩短率（LVFS）等指标。比较不同程度心衰患者自主神经功能异常程度，计算HRV指标与心超参数的相关性。结果 （1）DCM患者HRV较正常人明显降低。（3）心功能Ⅰ-Ⅱ级患者时域指标与正常人相比已避孕药下降；DCM患者LF/HF比值与LVEF，LVFS间存在中度正相关。结论 DCM患者自主神经功能受损，交感神经及迷走神经活性降低，交感-迷走神经功能平衡失调；这在疾病早期就已出现。HRV异常与心脏收缩功能障碍存在正相关。     

职业性哮喘患者心率变异性50例临床观察

选取2009年3月～2010年3月来我院就诊的50例职业性哮喘的患者与30例健康正常的群体分为观察组和对照组,并对两组的HRV进行时域和频域分析比较。职业性哮喘心率变异各项指标均明显异于正常组(P<0.05)。职业性哮喘非发作期存在自主神经功能紊乱。     

急性脑损伤对植物神经功能的影响

急性脑损伤如蛛网膜下腔出血、脑内出血、脑梗死、颅脑外伤等常导致心电图及心脏功能的变化 ,包括ＳＴ Ｔ改变、ＱＴ间期延长、各种心律失常、心脏射血能力降低、心室晚电位阳性率增加等 ,也有合并急性心肌梗死的报道 ,总称为脑心综合征[1,2 ] ,严重影响患者的预后及康复 ,甚至可造成患者猝死 ,推测其重要机制之一为脑损伤影响植物神经功能。本文就急性脑损伤对植物神经功能影响综述如下。1　监测植物神经功能重要手段心率变异性分析心率变异性 (Ｈｅａｒｔｒａｔｅｖａｒｉａｂｉｌｉｔｙ ,ＨＲＶ )分析是通过测量连续Ｒ Ｒ间期变化 (ｂｅ…     

抑郁患者的心率变异性分析

目的:对抑郁患者的心率变异性进行分析,评价自主神经张力的改变。方法:选择24例抑郁患者及正常对照组23例,进行HRV分析。结果:抑郁组SDANN、SDNN及rMSSD明显低于对照组,且SDANN均<100ms,LF/HF昼夜节律性变化消失。结论:抑郁患者交感神经张力明显增加,并引起交感神经和副交感神经平衡失常。     

心率变异的临床应用和分析方法

心率变异（Ｈｅａｒｔｒａｔｅｖａｒｉａｂｌｉｔｙ,ＨＲＶ）是指窦性心率在一定时间内周期性改变的现象。ＨＲＶ主要受自主神经调节,同时亦受呼吸、血压、皮肤温度、肾素一血管紧张素等多种因素影响~［１,２］。１９７８年ｗｏｌｆ等首先观察到ＨＲＶ程度可能是急性心肌梗死（ＡＭＩ）后死亡的一种预报因子,从而开始了心血管领域中对ＨＲＶ的广泛研究。特别是近１０ａ的研究已被认为ＨＲＶ是判断自主神经活动的最好方法,ＨＲＶ增高反映迷走神经活动增强;而降低则反映交感神经活动增强。后者可降低室颤域值,诱发致命性室性心律失常…     

老年带状疱疹后神经痛患者的自主神经功能观察

目的:观察老年带状疱疹后神经痛患者的自主神经状态。方法:选取老年带状疱疹后神经痛患者33例为观察组(P组),正常老年人50例为对照组(C组)。采用HRV检测仪,观察两组的心率变异性情况。结果:P组心率变异性频谱分析低频正常化单位(LF%)、低高频功率比值(LF/HF)明显高于C组(P>0.05);高频功率(HF)、低频功率(LF)和高频正常化单位(HF%)与C组相比无统计学差异性(P>0.05)。结论:老年带状疱疹后神经痛患者自主神经功能紊乱,交感神经功能处于优势。     

原发性高血压合并糖尿病患者心率变异性与自主神经功能的关系

目的 为了解高血压病合并糖尿病患者心率变异性与自主神经功能的关系，研究2型糖尿病(2型DM)合并原发性高血压(EH)与单纯2型DM、单纯EH对心率变异性(HRV)的影响。方法 对86例2型DM或EH患者(其中30例2型DM合并EH，28例为单纯2型DM，28例单纯EH)，进行24h HRV时域及频域分析。同时与年龄、性别相当的20例健康成年人HRV资料比较。结果 (1)单纯EH患者与对照组比较，代表心率总变异程度的全部正常R—R间期的标准差(SDNN)[(116&;#177;23)ms与(140&;#177;17)ms，P＜0，05]、每5min R-R间期均值的标准差(SDANN)[(110&;#177;21)ms与(131&;#177;22)ms，P＜0．05]和SDNN的均值(SDNNI)[(46&;#177;10)ms与(60&;#177;14)ms，P＜0．05]明显下降；代表迷走神经功能的正常相邻R—R间期差值的均方根(rMSSD)[(23&;#177;6)ms与(39&;#177;10)ms，P＜0．05]和正常相邻R—R间期差值＞50ms的百分比(PNN50)[(4．4&;#177;1．9)％与(9．6&;#177;3．6)％，P＜0．05]也有下降；频域招标VLF升高[(731&;#177;226)Hz与(440&;#177;237)Hz，P＜0．05)，HF[(351&;#177;36)Hz与(744&;#177;72)Hz,P＜0．05]和LF[(764&;#177;126)Hz与(963&;#177;156)Hz，P＜0．05]明显下降。(2)单纯DM患者与对照组比较，SDNN[(110&;#177;22)ms与(140&;#177;17)ms，P＜0．05]，SDANN[(106&;#177;20)ms与(131&;#177;22)ms，P＜0．05]和SDNNI[(44&;#177;11)ms与(60&;#177;14)ms,P＜0.05]明显下降；rMSSD[(22&;#177;6)ms与(39&;#177;10)ms,P＜0．05]和PNN50 [(4．2&;#177;1．6)％与(9．6&;#177;3．6)％，P＜0．05]也有下降；VLF升高[(716&;#177;256)Hz与(46&;#177;237)Hz,P＜0．05]，HF(320&;#177;48)Hz与(744&;#177;72)Hz,P＜0．05]和LF[(744&;#177;121)Hz与(963&;#177;156)Hz，P＜0．05]明显下降。(3)与单纯DM患者和单纯EH患者比较，有EH合并症的2型DM患者，SDNN[(96&;#177;18)ms与(110&;#177;22)ms，(116&;#177;23)ms，P＜0．01]、SDANN[(86&;#177;16)ms与(106&;#177;20)ms，(110&;#177;21)ms，P＜0．01]和SDNNI[(30&;#177;10)ms与(44&;#177;11)ms，(46&;#177;10)ms，P＜0．01]明显下降；rMSSD[(15&;#177;7)ms与(22&;#177;6)ms，(23&;#177;6)ms，P＜0．01]和PNN50[(2．4&;#177;1．2)％与(4．2&;#177;1．6)％，(4．4&;#177;1．9)％，P＜0．01]也明显下降；VLF升高[(1236&;#177;366)Hz与(716&;#177;256)Hz，(731&;#177;226)Hz,P&;lt;0．05]，HF[(169&;#177;25)Hz与(320&;#177;48)Hz，(351&;#177;36)Hz，P＜0．05]和LF[(544&;#177;108)Hz与(744&;#177;121)Hz，(764&;#177;126)Hz，P＜0．05]也明显下降。结论 EH患者和DM患者存在着HRV异常，其异常程度与病变轻重成正比，有EH合并症的DM患者异常更显著。     

Autonomic information flow improves prognostic value of heart rate patterns after abdominal aortic surgery

PURPOSE: Complex autonomic communication can be assessed by autonomic information flow (AIF) functions. The objective was to evaluate new complexity measures involving physiologically relevant time scales to predict the length of stay (LOS) in the hospital after abdominal aortic surgery (AAS). Our hypothesis was that AAS disrupts AIF, that restoration of AIF is necessary for recovery from major surgery, and that measures of AIF are superior to conventional heart rate variability (HRV) measures and equivalent to APACHE IV score in predicting LOS. MATERIALS AND METHODS: Twenty-four-hour Holter recordings were analyzed in 94 patients after AAS for standard time, frequency domain, and several complexity measures of different time scales derived from AIF functions. The risk of staying in the hospital for longer than 7 days as a function of HRV measures and APACHE IV score was modeled by logistic regression. The area under the curve (AUC) of receiver operating characteristic with 95% confidence interval as measure of predictive accuracy was calculated and internally cross-validated. RESULTS: The long-term decay of AIF over 100s (LD100) with cross-validated AUC = 0.67 (0.56-0.79) nearly reached the predictive accuracy of the APACHE IV score with AUC = 0.69 (0.58-0.79). None of the traditional time and frequency domain HRV measures remained in the multivariate models. The LD100 adjusted for ventilatory support with AUC = 0.70 (0.59-0.81) was equivalent to the APACHE IV score in this patient group. Although the strongest correlation between AIF measures and the APACHE IV score was found for LD100, r was only -0.37. CONCLUSIONS: Results confirm the hypothesis that AIF measures characterize pathophysiologic autonomic communication better than traditional HRV measures and may have similar predictive value to the APACHE IV score for LOS. The relative independence of the APACHE IV score and AIF measures suggests that AIF measures could add to clinical risk prediction.     

盐酸贝那普利对阵发性心房颤动患者自主神经功能的影响

目的:观察服用盐酸贝那普利后老年特发性阵发性心房颤动(IPAF)患者心率变异性的变化,评价盐酸贝那普利对IPAF患者自主神经功能的影响。方法:选取老年IPAF患者50例,给予贝那普利治疗4周,治疗前后分别进行24 h动态心电图检测和HRV分析。结果:治疗后老年IPAF患者的心率变异性明显升高。结论:盐酸贝那普利可以改善老年IPAF患者的自主神经功能。     

Autonomic pain responses during sleep: A study of heart rate variability

The autonomic nervous system (ANS) reacts to nociceptive stimulation during sleep, but whether this reaction is contingent to cortical arousal, and whether one of the autonomic arms (sympathetic/parasympathetic) predominates over the other remains unknown. We assessed ANS reactivity to nociceptive stimulation during all sleep stages through heart rate variability, and correlated the results with the presence of cortical arousal measured in concomitant 32‐channel EEG. Fourteen healthy volunteers underwent whole‐night polysomnography during which nociceptive laser stimuli were applied over the hand. RR intervals (RR) and spectral analysis by wavelet transform were performed to assess parasympathetic (HF^WV) and sympathetic (LF^WV and LF^WV/HF^WV ratio) reactivity. During all sleep stages, RR significantly decreased in reaction to nociceptive stimulations, reaching a level similar to that of wakefulness, at the 3rd beat post‐stimulus and returning to baseline after seven beats. This RR decrease was associated with an increase in sympathetic LF^WV and LF^WV/HF^WV ratio without any parasympathetic HF^WV change. Albeit RR decrease existed even in the absence of arousals, it was significantly higher when an arousal followed the noxious stimulus. These results suggest that the sympathetic‐dependent cardiac activation induced by nociceptive stimuli is modulated by a sleep dependent phenomenon related to cortical activation and not by sleep itself, since it reaches a same intensity whatever the state of vigilance.     

维持性血液透析患者心率变异性对心源性死亡率的影响

目的评估心率变异性(heart rate variability,HRV)下降对终末期肾脏病维持性血液透析患者的临床意义及对心源性死亡率的影响。方法对64例维持性血液透析患者[年龄(58±15)岁,男性25例,透析时间(42±54)月]进行24h动态心电图描述并分析时域和频域HRV指标。结果参试患者与30例健康人群对照,HRV显著性减低。在2年随访期间中,共有13例患者死亡(20.3%);6例为心源性死亡、7例为非心源性死亡。Cox生存分析提示,在HRV检测指标中,窦性心搏间期标准差(SDNN)、超低频功率、RR间期心率变异比值(LF/HF)对于心源死亡有显著性指示意义。而对非心源死亡病例,HRV检测各指标均无显著性指示意义。结论 HRV指标水平降低,对于维持性血液透析患者的心源性死亡有显著性预测意义。     

植物神经功能与冠心病患者室性心律失常的相关性研究

目的：探讨植物神经功能与冠状动脉粥样硬化性心脏病（简称冠心病）患者室性心律失常的关系。方法：对我院126例进行了动态心电图检查及心率变异性（heartrate variability,HRV）分析的冠心病患者的室性心律失常和HRV指标进行回顾性分析。并应用Logistic回归筛选冠心病患者室性心律失常的HRV预测指标。结果：HRV各项时域指标和频域指标中的LF、VLF、HF均有随着室性心律失常程度的加重而降低的趋势．时域指标中的SDNN、SDANN、ASDNN、PNN50b与室性心律失常程度呈弱负相关（P〈0．01或P〈0．05）。Logistic回归结果表明SDANN为冠心病患者室性心律失常的保护因素。结论：HRV与冠心病患者室性心律失常程度呈弱负相关。SDANN为冠心病患者室性心律失常的保护因素。早期对植物神经功能紊乱进行干预治疗,可能有利于减少冠心病患者室性心律失常的发生     

Autonomic control of the heart and peripheral vessels in human septic shock

Objective Circulating endotoxin impairs the sympathetic regulation of the cardiovascular system in animals. We studied the changes in the autonomic control of the heart and circulation during septic shock in humans.Design 12 patients (age 43.0±6, 17–83 years) were investigated during septic shock (mean duration: 3.5±0.5 days) and during recovery, fluctuations in R-R interval, invasive arterial pressure (AP) and peripheral arteriolar circulation (PC, photoplethysmography) were evaluated by spectral analysis as a validated nonivasive measure of sympathovagal tone. Apache II score was adopted as the disease severity index. Low frequency components (0.03–0.15 Hz) of the frequency spectra were expressed as relative to the overall variability (LFnu) for each cardiovascular variable.Results LFnu were low or absent during shock but, in the 10 patients who recovered, increased by the time of discharge (post-shock). R-R LFnu increased from 17±6 to 47±9 (p<0.03), AP LFnu from 6±3 to 35±4 (p<0.02) and PC LFnu from 18±3 to 66±4 (p<0.001). Apache II fell from 23.1±1, at admission, to 14.8±1.8 at discharge (p<0.005). Two patients died showing no LFnu increase.Conclusion Reduced LF components of the variability of cardiovascular signals are characteristic of septic shock, confirming the presence of abnormal autonomic control. Restored sympathetic (LF) modulation seems to be associated with a favourable prognosis.     

糖尿病患者心率变异性改变的临床意义

目的探讨糖尿病患者自主神经的功能。方法对120例糖尿病患者和120例正常组进行心率变异性时域和频域分析。结果糖尿病组与正常组比较,SDNN（75．96±33．78,147．01±27．66）、SDANN（66．35±26．69,123．48±35．07）、SDNNindex（39．35±23．52,52．43±16．67）、rMSSD（15．91±7．55,34．99±15．61）、PNN50（1．62±3．12,10．41±7．35）、TF（6．03±0．76,6．86±0．63）、LF（5．25±0．93,5．80±0．75）、HF（4．19±0．82,4．72±0．86）显著降低（P〈0．01）。结论糖尿病患者心率变异性降低明显。     

Acupuncture increases parasympathetic tone,modulating HRV − Systematic review and meta-analysis

IntroductionAn increasing number of studies have demonstrated that acupuncture can influence Autonomic Nervous System functions. Heart Rate variability (HRV) is one widely used marker of autonomic activity. The main objective of this systematic review is to critically assess the evidence from randomized clinical trials (RCTs) regarding the effect of acupuncture on HRV as compared to placebo methods.MethodEMBASE, Pubmed, The Cochrane Library, Web of Science, Scopus electronic databases were searched until 9 September 2020 for RCTs in which human subjects were treated with needle acupuncture using acupoints of the body without electric stimulation.ResultsThe searches identified 1698 potentially relevant articles, 9 RCTs were included. The statistical analysis of the available data showed that the changes between pre and post treatment HF (high frequency) and LF/HF (high frequency/low frequency) values in Verum group were significant, while there were no significant changes in these parameters in Sham groups.Conclusionthe results of this meta-analysis suggest that real acupuncture has superior effect over placebo acupuncture in increasing parasympathetic tone and in this way may improve physical well-being. Due to the quality of primary studies and degree of heterogeneity the results should be interpreted cautiously.     

Effect of Beta Adrenergic Receptor Blockade on Cardiac Autonomic Tone in Patients with Chronic Stable Angina

Decreased heart rate variability, which may be due to increased sympathetic and decreased parasympathetic activity, has been shown to be a predictor of cardiac events after acute myocardial infarction. The present study was undertaken to analyze the effect of beta adrenergic blockade on cardiac autonomic system in patients with chronic stable angina. Nineteen patients (15 males and 4 females, age range 44–74 years) with chronic stable angina were enrolled. After stopping all cardiac medications, patients had two baseline treadmill tests with both reproducible angina and ST depression and a baseline 48-hour ambulatory ECG recording. A long-acting beta-blocker (atenolol or betaxolol) was started and titrated to the maximal tolerated dose. After 1–2 months, a repeat 48-hour ambulatory ECG recording on beta-blocker therapy was obtained. Heart rate variability analysis was performed on the baseline and drug therapy ECG recordings. The average heart rate significantly decreased (P < 0.008), and the mean RR interval significantly increased (P < 0.0001). In the time-domain analysis, the standard deviation, variance, ASDNN5, and SDANN5 were not significantly affected, although the PNN50 increased. In the frequency domain, the total power (P < 0.0001) and the low frequency (P < 0.001) components decreased, while the high frequency spectrum was unchanged. Thus, sympathetic activity significantly declined in patients with chronic stable angina on beta-blocker therapy, while parasympathetic tone demonstrated a heterogenous response.