电针心经不同节段对家兔心上交感神经丛放电活动的影响

背景：经脉脏腑相关是针灸经络理论的核心，也是针灸作用机制研究的切入点和突破口。本文从心经与支配心脏交感神经电活动关系的角度探讨针灸经络理论的核心内容。目的：观察电针心经不同节段对家兔心上交感神经丛放电活动的影响。设计：随机对照动物实验。单位：安徽中医学院经脉脏腑相关研究中心实验室。材料：实验于2004-03在安徽中医学院经脉脏腑相关研究中心实验室开展，共选健康青紫兰家兔36只，体质量（2．8&;#177;0．3）kg。随机分为3组，每组12只，即电排针刺激心经腕部（“神门”区）、肘部（“少海”区）和腋部（“极泉”区）经脉主干3组。方法：每次每组各选1只同性别、体质量差小于10％的家兔，同步进行实验。在Olympus解剖显微镜（日本）下分离心上交感神经丛，埋植多股不锈钢丝双极电极，进口专用凝胶（美国产）固定后，关闭胸腔，控制肛温（39&;#177;0．5）℃，50mL／L葡萄糖等渗液静脉滴注维护2h后电针。记录分析心率变异性和心上交感神经丛放电活动的变化。主要观察指标：电针后各组动物的心率变异性、功率谱高频／低频值分析。结果：纳入家兔共3组，每组12只，均进入结果分析。电针后，各组心率变异性的总心率变异性值和心上交感神经丛放电活动频率增高，功率谱高频／低频比值下降，以电针腕部组为著，肘部组次之，腋部组最弱。结论：电针心经不同节段，均可促进心上交感神经丛放电活动，增强左心功能，且以心经腕部经脉主干与左心功能间关系最为密切。     

电针对家免Oddi括约肌运动及其相关脑肠肽的影响

背景:"经脉一脏腑相关"是针灸经络学说中主要的研究内容之一,课题以一个脏腑为基础研究其与多条经脉之间的关系,探讨经脉与脏腑之间是甭存在相对特异性.目的:通过电针足三阳经穴对家兔Oddi括约肌肌电发放及其相关脑肠肽胆囊收缩素浓度的影响,探讨针刺对Oddi括约肌的调整作用.设计、时间及地点:随机对照动物实验,于2005-01/2007-12在湖南中医药大学针灸推拿学重点实验室完成.材料:新西兰大耳白兔60只,体质量2.0～2.5 kg,雌雄不拘,随机分为空白组、阿托品组、足三里组、阳陵泉组、四白组、承筋组,每组10只.方法:各组兔用生理记录仪记录Oddi括约肌肌电活动1 h后,除空白组滴注生理盐水外,其余各组均静滴阿托品,静滴的同时足三里、阳陵泉、四白、承筋组分别电针相应腧穴20 min.主要观察指标:记录处理前、后Oddi括约肌肌电各1 h,放射免疫法检测血浆及Oddi括约肌组织内胆囊收缩素的浓度.结果:与阿托品组比较:空白组、叫白、足二里、阳陵泉组慢波高活动相及快波平均振幅升高(除足三里组快波外,均为P<0.01或P<0.05);四白、足二里、阳陵泉组均能使Oddi括约肌组织及血浆巾胆囊收缩素的浓度升高(除足三里组Oddi括约肌组织胆囊收缩素浓度外,均为P<0.01或P<0.05),产生上调的效应依次为:四白组>阳陵泉组>足三里组.结论:经(穴)对所辖脏腑存在着或直接或间接的、特异性的调控作用,胆囊收缩素是针刺对胆道系统运动起调节作用的重要脑肠肽之一.     

电针内关穴对急性心肌缺血家兔延髓β内啡肽含量的影响

背景有研究表明,起源于延髓孤束核的β内啡肽能神经元可参与心血管活动的调节.目的探讨电针内关对急性心肌缺血家兔延髓中β内啡肽含量的影响.设计完全随机的双盲对照实验研究.地点、材料和干预本实验在湖北中医学院针灸中心实验室完成.实验选用日本大耳白兔30只,雌雄不限.按随机数字表法分为假手术组(10只)、模型组(10只)、电针组(10只).结扎左冠状动脉前降支造成心肌缺血模型,针刺双侧内关,接通G6805电针治疗仪,连续波,振幅12 V,频率7 Hz,强度6mA,留针30min.检测3组白兔新鲜延髓组织β内啡肽含量.主要观察指标电针内关对急性心肌缺血家兔延髓中β内啡肽含量的影响.结果β内啡肽含量(ng/L)假手术组15.82±1.802,模型组23.47±1.567,电针组17.32±1.876.模型组与假手术组比较,造模后急性心肌缺血家兔延髓中β内啡肽的含量明显升高(F=4.68,P＜0.05);通过电针内关治疗后,电针组与模型组比较,急性心肌缺血家兔延髓中β内啡肽含量明显降低(F=4.13,P＜0.05).结论电针内关可以调节脑组织中β内啡肽的含量,改善缺血心肌组织供血,这可能是针灸发挥治疗作用的重要机制之一.     

电针内关穴对急性心肌缺血家兔延髓β内啡肽含量的影响

背景：有研究表明，起源于延髓孤束核的β内啡肽能神经元可参与心血管活动的调节。目的：探讨电针内关对急性心肌缺血家兔延髓中β内啡肽含量的影响。设计：完全随机的双盲对照实验研究。地点、材料和干预：本实验在湖北中医学院针灸中心实验室完成。实验选用日本大耳白兔30只，雌雄不限。按随机数字表法分为假手术组(10只)、模型组(10只)、电针组(10只)。结扎左冠状动脉前降支造成心肌缺血模型，针刺双侧内关，接通G6805电针治疗仪，连续渡，振幅12V，频率7Hz，强度6mA，留针30min。检测3组白兔新鲜延髓组织β内啡肽含量。主要观察指标：电针内关对急性心肌缺血家兔延髓中β内啡肽含量的影响。结果：β内啡肽含量(ng／L)：假手术组15．82&;#177;1．802，模型组23．47&;#177;1．567，电针组17．32&;#177;1．876。模型组与假手术组比较，造模后急性心肌缺血家兔延髓中β内啡肽的含量明显升高(F=4．68，P&;lt;0．05)；通过电针内关治疗后，电针组与模型组比较，急性心肌缺血家兔延髓中β内啡肽含量明显降低(F=4．13，P&;lt;0．05)。结论：电针内关可以调节脑组织中β内啡肽的含量，改善缺血心肌组织供血，这可能是针灸发挥治疗作用的重要机制之一。     

电针对心肌缺血患者心功能及心交感神经电活动的影响

目的观察电针不同经穴对心肌缺血患者心功能及心交感神经电活动的影响。 方法采用随机数字表法将90例心肌缺血患者分为常规治疗组、电针神门组及电针支正组,每组40例患者。3组患者均给予常规药物治疗（包括口服阿司匹林、β受体阻滞剂、ACE抑制剂或ARB、他汀类调脂药物等）,电针神门组及电针支正组患者分别在此基础上辅以电针神门穴或电针支正穴治疗。于治疗前、治疗1个月后采用Biopac生物信号采集系统检测并记录3组患者心交感神经电信号、心率、室内压上升段最大上升速率、室内压下降段最大下降速率、左心室收缩压力峰值等心功能指标。 结果经治疗10d后,发现电针神门组及电针支正组心交感神经放电频率均较常规治疗组明显改善,组间差异均具有统计学意义(P<0.05);经治疗20,30d后,发现电针神门组患者心交感神经放电频率显著高于电针支正组及常规治疗组,组间差异均具有统计学意义(P<0.05)。经1个月治疗后,发现3组患者各项心功能指标均逐渐恢复;进一步分析发现,治疗10,20d时电针神门组及电针支正组各项心功能指标均较常规治疗组明显改善,组间差异均具有统计学意义(P<0.05),并且上述时间点电针神门组各项心功能指标亦显著优于电针支正组水平,组间差异均具有统计学意义(P<0.05)。 结论电针神门穴或支正穴均可显著改善心肌缺血患者心脏交感神经电活动及心脏功能,且电针神门穴对心肌缺血患者的治疗作用优于电针支正穴治疗。     

电针心经、小肠经对心肌缺血损伤大鼠心电图和心肌酶学的影响

目的:观察电针心经、小肠经对急性心肌缺血模型大鼠心电图和心肌酶学的影响,以验证心经与小肠经的表里经关系.方法:采用冠状动脉左降支结扎复制大鼠急性心肌缺血模型.电针刺激心经"神门-通里"或小肠经"养老-支正"段,并电针刺激肺经"太渊-列缺"段作为对照,观察急性心肌缺血模型大鼠心电图和心肌酶学变化情况.结果:与伪手术组相比,模型组、肺经组、心经组和小肠经组大鼠心电图异常率均有显著性差异(P＜0.01),而模型组、肺经组、心经组和小肠经组组间比较,差异无显著性(P＞0.05).与伪手术组相比,模型组大鼠心率下降明显(P＜0.05),心经组和小肠经组大鼠心率恢复也较明显(P＜0.05).与伪手术组比较,模型组CK和LDH值差异有显著性(P＜0.01);与模型组比较,心经组和小肠经组CK和LDH值差异有显著性(P＜0.01或0.05);与肺经组比较,心经组和小肠经组CK和LDH值差异有显著性(P＜0.01或0.05).结论:电针心经、小肠经可改善急性心肌缺血大鼠ECG,降低急性心肌缺血大鼠血清CK和LDH活性水平,对急性心肌缺血具有保护作用.     

电针对家兔Oddi括约肌运动及其相关脑肠肽的影响

背景：“经脉脏腑相关”是针灸经络学说中主要的研究内容之一,课题以一个脏腑为基础研究其与多条经脉之间的关系,探讨经脉与脏腑之间是否存在相对特异性。目的：通过电针足三阳经穴对家兔0ddi括约肌肌电发放及其相关脑肠肽胆囊收缩素浓度的影响,探讨针刺对0ddi括约肌的调整作用。设计、时间及地点：随机对照动物实验,于2005—01／2007—12在湖南中医药大学针灸推拿学重点实验室完成。材料：新两兰大耳白兔60只,体质量2．0～2．5kg,雌雄不拘,随机分为空白组、阿托品组、足三里组、阳陵泉组、四白组、承筋组,每组10只。方法：各组兔用生理记录仪记录0ddi括约肌肌电活动1h后,除空白组滴注生理盐水外,其余各组均静滴阿托品,静滴的同时足三里、阳陵泉、四白、承筋组分别电针相应腧穴20min。主要观察指标：记录处理前、后0ddi括约肌肌电各1h,放射免疫法检测血浆及Oddi括约肌组织内胆囊收缩素的浓度。结果：与阿托品组比较：空白组、四白、足三里、阳陵泉组慢波高活动相及快波平均振幅升高（除足j里组快波外,均为P〈0．01或P〈0．05）：四白、足二里、阳陵泉组均能使0ddi括约肌组织及血浆中胆囊收缩素的浓度升高（除足三里组0ddi括约肌组织胆囊收缩素浓度外,均为P〈0．01或P〈0．05）,产生上调的效应依次为：四白组〉阳陵泉组〉足三里组。结论：经（穴）对所辖脏腑存在着或直接或间接的、特异性的调控作用,胆囊收缩素是针剌对胆道系统运动起调节作用的重要脑肠肽之一。     

甲状腺次全切除术中电针刺激血浆儿茶酚胺的变化

目的:观察甲状腺次全切除术中电针刺激双侧“合谷”、“内关”穴对儿茶酚胺的干预效果。方法:①选取2005-05/2006-03暨南大学附属第一医院拟行择期甲状腺次全切除术的住院患者60例,按随机对照Doll’s法分为电针刺激 颈丛阻滞组、单纯颈丛阻滞组,各30例。两组患者性别、年龄、身高、体重、手术时间、病种等差异均无显著性意义(P>0.05)。②电针刺激 颈丛阻滞组患者分别于双侧“内关”、“合谷”穴皮肤消毒后刺入银针,直到有明显“得气”感觉,接上电刺激仪连续高频密波刺激(60Hz,1～2mA,20V),以能耐受无特殊不适为度,观察约10min后行双侧颈深丛阻滞。单纯颈丛阻滞组不给予电针刺激,只以同法行颈丛阻滞。③分别于麻醉前(t1)、双侧颈丛阻滞后5min(t2)、切开皮肤(t3)、剥离甲状腺(t4)、缝皮前(t5)、缝皮后5min(t6)各时间点记录两组平均动脉血压、心率、手指血氧饱和度、肾上腺素、去甲肾上腺素的变化。同时对患者术中疼痛程度(0分=无痛,10分=剧痛)及镇静与紧张程度(0分=轻松舒适,10分=紧张不适)进行评分。观察围术期并发症和毒副反应。结果:按实际处理分析,实验选取拟行择期甲状腺次全切除术的住院患者60例,电针刺激 颈丛阻滞组有1例患者因冰冻切片为甲状腺癌需行扩大根治术改全身麻醉而剔除。①围术期神经内分泌应激反应指标-儿茶酚胺检测结果:单纯颈丛阻滞组肾上腺素浓度在剥离甲状腺、缝皮前、缝皮后5min明显高于电针刺激 颈丛阻滞组(P<0.01),去甲肾上腺素浓度于缝皮前、缝皮后5min明显高于电针刺激 颈丛阻滞组(P<0.05)。②围术期各项循环指标检测结果:术中平均动脉血压电针刺激 颈丛阻滞组比较稳定,而单纯颈丛阻滞组波动明显,于切开皮肤、剥离甲状腺、缝皮前明显升高(P<0.01);单纯颈丛阻滞组心率于切开皮肤、剥离甲状腺时间点明显高于电针刺激 颈丛阻滞组(P<0.01);两组手指血氧饱和度基本相似(P>0.05)。③术中疼痛程度评分、镇静与紧张程度评分结果:电针刺激 颈丛阻滞组患者术中疼痛程度评分、镇静与紧张程度评分均明显低于单纯颈丛阻滞组(P<0.01)。④围术期并发症和毒副作用:术后恶心呕吐发生率电针刺激 颈丛阻滞组明显低于单纯颈丛阻滞组(P<0.05)。结论:电针刺激“合谷”、“内关”穴联合颈丛阻滞应用于甲状腺切除手术较单纯颈丛阻滞效果更好,明显减轻心血管系统和神经内分泌系统应激反应。     

兔颈部迷走及交感和减压神经刺激放电记录方法学建立

目的探讨并建立稳定的兔颈部迷走、交感和减压神经刺激放电记录的方法学。方法新西兰大白兔20只,随机分为刺激组和起搏组各10只。刺激组暴露并刺激双侧颈部迷走神经、交感神经和减压神经,观察刺激前、后心率和血压变化情况;起搏组行快速右心房起搏(起搏频率600次/min),2倍舒张期阈值电压持续起搏12h,观察起搏前、后神经放电情况。结果刺激组刺激颈部迷走神经后心率[(105±15)次/min]和平均动脉压[(64±6)mm Hg]低于刺激前[(276±19)次/min、(85±3)mm Hg](P0.05);刺激颈部减压神经后平均动脉压[(53±4)mm Hg]低于刺激前[(86±6)mm Hg](P0.05),心率与刺激前比较差异无统计学意义(P0.05);刺激颈部交感神经后心率和平均动脉压与刺激前比较差异均无统计学意义(P0.05);起搏组起搏前可记录到减压神经放电,但未记录到明显的交感和迷走神经放电,快速高位右心房起搏12h后可记录到明显的交感神经、迷走神经放电信号。结论采用颈部分离交感神经、迷走神经和减压神经,可获得稳定、高重复性、高质量的神经刺激和放电记录数据。     

电针对运动后心率恢复异常冠心病患者心肺功能及生存质量的影响

目的:探讨电针对于心肺运动试验后2min时心率恢复值异常的冠心病患者心肺功能及生存质量的影响。方法:纳入70例经冠脉造影检查确诊为冠心病且在心肺运动试验终止2min时心率恢复值(HRR2)异常的患者,随机分为以下两组并给予12周相应干预:(1)电针组35例,常规用药管理和电针治疗;(2)对照组35例,常规用药管理。12周治疗前后通过心肺运动负荷试验、心率变异性检测测定两组患者的静息心率(RHR)、HRR2、峰值摄氧量(peak VO_2)、无氧阈(AT)、峰值通气量(peak VE)、峰值功率(peak Power)、心率变异性指标,以及简明健康量表(SF-36)评分。结果:12周后,电针组RHR、HRR2、peak VO_2、AT、peak Power及心率变异性指标均优于治疗前(P0.05),SF-36量表在身体疼痛(BP)、生理功能(PF)、生理职能(RP)、总体健康(GH)、活力(VT)、社会功能(SF)6个维度评分高于治疗前(P0.05);而对照组对应指标与治疗前相比无显著性差异(P0.05)。组间比较,电针组RHR、HRR2、peak VO_2、AT、peak Power结果均显著高于对照组(P0.05),而两组间peak VE相比则无显著性差异(P0.05);SF-36评分在BP、PF、RP、GH、VT、SF这6个维度上显著高于对照组(P0.05)。结论:电针在改善心率恢复异常冠心病患者的心率恢复情况的同时,可以显著提高患者心肺功能以及生存质量。     

Acupuncture in migraine: investigation of autonomic effects

OBJECTIVE: A dysregulation of the autonomic nervous system is discussed as a pathogenetic factor in migraine. As acupuncture has been shown to exhibit considerable autonomic effects, we tested whether the clinical effects of acupuncture in migraine prophylaxis are mediated by changes of the autonomic regulation. METHODS: We simultaneously monitored changes of heart-rate variability (HRV) as an index of cardiac autonomic control and clinical improvement during an acupuncture treatment in 30 migraineurs. HRV was derived from spectral analysis of the electrocardiogram, which was performed before, during, and after the first and the last session of a series of 12 acupuncture sessions. Migraineurs were randomly allocated to 2 groups receiving either verum acupuncture (VA) or sham acupuncture (SA) treatment. RESULTS: Across the combined VA and SA groups, the clinical responders (with at least 50% reduction of migraine attacks) exhibited a decrease of the low-frequency (LF) power of HRV in the course of the treatment, which was not be observed in patients without clinical benefit. VA compared with SA induced a stronger decrease of high-frequency power. The mode of acupuncture, however, did not have an impact on the LF component of HRV or the clinical outcome. DISCUSSION: The data indicate, that VA and SA acupuncture might have a beneficial influence on the autonomic nervous system in migraineurs with a reduction of the LF power of HRV related to the clinical effect. This might be due to a reduction of sympathetic nerve activity. VA and SA induce different effects on the high-frequency component of HRV, which seem, however, not to be relevant for the clinical outcome in migraine.     

Assessment of autonomic nervous system functions in patients with vitamin B12 deficiency by power spectral analysis of heart rate variability

The purpose of this study was to test the autonomic nervous system function of patients with vitamin B12 deficiency (megaloblastic anemia) by measuring heart rate variability (HRV). The study population consisted of 17 vitamin B12 deficient patients and 15 age- and sex-matched normal volunteers. HRV was measured by power spectral analysis from which power of the low frequency (LF) peak (0.04-0.15 Hz), normalized units of the LF peak (LFNU), power of the high frequency (HF) peak (0.15-0.4 Hz), normalized units of the HF (HFNU), and ratio of power of LF to power of HF (LF:HF) were calculated. Vitamin B12 deficient patients had lower LF, LFNU, HF, HFNU, and LF:HF ratio than normal volunteers (P < 0.05). Decreases in sympathetic indices (LF and LFNU) were greater than those measured in parasympathetic indices (HF and HFNU). All HRV parameters correlated positively with the level of vitamin B12 (P < 0.001) and negatively with the duration of disease (P < 0.001). After vitamin B12 replacement the HRV parameters of patients and controls became comparable (P > 0.05). Our data suggest that autonomic sympathetic and parasympathetic nervous activities are decreased in patients with vitamin B12 deficiency, an abnormality that can be corrected by vitamin B12 replacement therapy.     

甲亢病人的心率变异性及临床意义

目的 :通过对 31例甲状腺机能亢进症 (简称甲亢 )患者 (甲亢组 )和 31例正常人 (对照组 )的心率变异性 (HRV)的分析 ,进一步了解甲亢患者自主神经功能状况。方法 :对甲亢组和对照组进行 2 4hHRV对比分析。结果 :甲亢组与对照组比较其时域指标 :SDNN、SDANN明显降低 ,频域指标 :VLF、LF/HF增高 (P <0 .0 0 1,P <0 .0 5 ) ,LF、HF降低 ,与对照组有显著差异 (P<0 .0 0 1,P <0 .0 5 )。结论 :通过HRV的变化 ,进一步说明甲亢患者的交感神经受损和迷走神经失衡。     

Heart rate variability during sleep and sleep apnoea in a population based study of 387 women

Increased sympathetic activity during sleep has been suggested as a link between obstructive sleep apnoea syndrome and cardiovascular disease. Heart rate variability (HRV) is a measure of autonomic effect on the heart. Different parameters have been associated with sympathetic and parasympathetic activity. We have studied HRV in different sleep stages and related the HRV‐pattern to sleep apnoea in a population‐based sample of 387 women. We investigated the HRV‐parameters standard deviation of all R‐R intervals (SDNN), root of the averaged square of successive differences (RMSSD), low frequency component (LF), high frequency component (HF), ratio of low frequency component to high frequency component LF/HF and VSAI [variation in sympathetic activity between rapid eye movement (REM) and slow wave sleep, defined as LF_REM?LF_SWS]. The HRV‐parameters were compared with the results of a full‐night polysomnography. Hourly incidence of obstructive episodes was used for classifying the subjects into four apnoea‐hypopnoea index (AHI)‐groups (<5, ≥5 and <15, 15–30 and >30 events). Individual sleep stages were analysed by pooling all recordings. Women with high AHI had higher heart rate and LF/HF ratio. In subjects with AHI >30, LF/HF ratio however dropped to same level as with AHI <5. Subjects with high AHI had low VSAI. Levels of SDNN, LF and LF/HF ratio during REM and light sleep were similar to wakefulness. In slow wave sleep the parameters decreased. In conclusion, moderately increased prevalence of obstructive apnoeas was associated with signs of higher sympathetic activity. High AHI was however associated with a HRV‐pattern suggestive of depressed sympathetic drive and lowered ability to increase it during REM.     

Is There Increased Sympathetic Activity in Patients with Mitral Valve Prolapse?

The aim of this study was to investigate autonomic nervous system tone in patients with mitral valve prolapse (MVP). Heart rate variability (HRV) was assessed from 24-hour ambulatory Holter recordings in 28 patients with primary MVP and in 28 age and sex matched normal control subjects in a drug-free state. Sixteen of the MVP patients were symptomatic and 12 asymptomatic. Spectral HRV was calculated in terms of low (LF: 0.06–0.15 Hz) and high (HF: 0.15–0.40 Hz) frequency components using fast Fourier transform analysis, and the ratio LF/HF was calculated. Spectral analysis of HRV showed that the MVP patients, taken as a single group, had lower HF and LF and a higher LF/HF ratio than the controls. No significant difference in HRV was found between the 16 symptomatic and the 12 asymptomatic patients, but the symptomatic patients had a significantly higher LF/HF ratio than the controls. Our observations suggest that, during normal daily activities, patients with MVP experience a significant deviation in autonomic nervous system tone with predominance of the sympathetic branch. This predominance is more marked in symptomatic patients.     

Role of Sympathovagal Balance in the Initiation of Idiopathic Ventricular Tachycardia Originating from Right Ventricular Outflow Tract

VT originating from the right ventricular outflow tract (RVOT) is prone to occur when sympathetic nervous activity is increased. β-Blockade is, therefore, effective in suppressing this VT. The purpose of this study was to determine the role of sympathovagal balance assessed by heart rate variability (HRV) in the spontaneous initiation of repetitive premature ventricular contractions (PVCs) and VT (five or more consecutive PVCs) arising from RVOT in seven patients without structural heart diseases. Frequency-domain measures of HRV were determined by analyzing 24-hour Holter electrocardiographic recording with the maximum entropy method over α 1,280-second period immediately before the onset of 35 single PVCs, 26 episodes of 2-4 consecutive PVCs, and 21 episodes of VT. High frequency component (HF: 0.15–0.40 Hz) was used as an index of parasympathetic activity, and the ratio of low frequency component (LF: 0.04–0.15 Hz) to HF (LF/HF ratio), as an index of sympathovagal balance. NN50(%), a time-domain variable of parasympathetic activity, was also determined. Mean RR interval and any measures of HRV did not change significantly before single PVCs. Mean RR interval shortened and HF decreased prior to repetitive PVCs and VT. The LF/HF ratio, however, increased only before the onset of VT. NN50(%) tended to decrease before repetitive PVCs and decreased significantly before VT. With propranolol (30–60 mg/day), frequency of repetitive PVCs was suppressed from 2,048 ± 1,201 to 746 ± 658/day and VT was totally abolished, but frequency of single PVCs did not change significantly. In conclusion, sympathetic predominance plays an important role in the initiation of repetitive PVCs and VT originating from RVOT in patients without structural heart diseases.     

Heart rate variability during sleep in patients with vasovagal syncope

Background: There are a few studies showing no significant heart rate variability (HRV) over a 24-hour period in vasovagal syncope (VVS) patients, but no research has examined HRV and its sympathetic and parasympathetic components during rapid eye movement (REM) and non-REM sleep. The authors hypothesized that REM sleep might be a critical state in which VVS patients would show abnormal responses.
Objectives: To analyze the sympathetic and parasympathetic components of HRV during REM and SWS in patients with VVS compared to normal subjects, and in patients with positive HUTT compared to negative ones.
Methods: Thirty-seven VVS patients and 20 normal age-matched controls were submitted to polysomnography with 24-hour Holter monitoring to assess HRV. Time and frequency domain techniques were carefully performed for 24 hours and during Stages 3 and 4 of REM and non-REM sleep. Variation of sympathetic activity index (VSAI) was defined as the difference in the low frequency (LF) component of HRV between REM and Stages 3 and 4 of non-REM sleep. An analysis of variance was performed to compare patients and controls; patients with positive and negative head-up tilt testing.
Results: The LF component was lower in syncope compared to normal patients (1,769.54 ± 1,738.17, 3,225.37 ± 2,585.05, respectively, P = 0.03). There was a significant decrease in VSAI in the syncope group compared to the control group (−539.39 ± 1,930.78, 1,268.10 ± 2,420.20, respectively, P = 0.01). The other sleep variables analyzed including very LF, high frequency, low frequency/high frequency and time domain parameters did not reach statistical significance. Syncope patients also showed an increase in slow wave sleep (28.2 ± 10.5, 19.7 ± 7.8, P = 0.01).
Conclusions: VVS patients exhibited sympathetic suppression during REM sleep. Possible mechanisms are discussed in this article.     

慢性肺心病患者的心率变异性

目的：观察慢性肺心病患者心率变异性，了解其自主神经功能的变化。方法：对25例慢性肺心病，25例健康对照者（对照组）作前瞻性对照研究，记录24h动态心电图，作时域和频域分析，结果：与对照组比较，肺心病组相邻心搏的R－R间期之差＞50ms的心搏数占R－R间期数的百分(pNN50)，每5min正常R－R间期标准差的平均值（SDANN），频域指标的高频（HF）明显降低，低频与高频的比值（LF／HF），明显升高，差异均有非常显著意义（P均＜0．01），而频域指标的低频（LF）无明显变化（P＞0．05），经过治疗后，肺心病组处于缓解期，与治疗前比较，HF，PNN50，SDANN等指标明显增加，而LF／HF明显降低，差异均有非常显著意义（P均＜0．01），肺心病组病人治疗后HF，pNN50,SDANN等指标均低于对照组，而LF／HF明显高于对照组，差异均有非常显著意义（P均＜0．01），肺心病组治疗后LF与治疗前及对照组比较，差异不具显著意义（P＞0．05）。结论：肺心中层得不仅交感神经活动占优势，同时并存迷走神经功能受损，自主神经功能可能存在连续性障碍。     

急性冠脉综合征心率震荡昼夜节律及其与心率变异的相关性分析

目的 研究急性冠脉综合征患者心率震荡(heart rate turbulence,HRT)的昼夜节律性,并通过HRT指标与心率变异性指标的相关性分析,进一步探讨HRT与自主神经的关系.方法 连续入选急性冠脉综合征患者91例,分析一天中的两个时段即白天(7: 00～19: 00)和夜间(0: 00～6: 00)HRT的变化.从上午7: 00和凌晨0: 00开始各按顺序入选3个室早,根据文献计算HRT指标[震荡初始(TO)、震荡斜率(TS)]的数值.心率变异性选用的时域指标有SDNN、RMSSD,频域指标包括LF、HF、LF/HF.结果 ①TO值白天较夜间高,TS值白天较夜间低,均存在明显的昼夜节律.②TS与SDNN之间存在正相关关系(r=0.44),TS与LF/HF之间亦存在正相关关系(r=0.51).结论 急性冠脉综合征HRT存在昼夜节律变化且与HRV密切相关,提示HRT不仅反映心血管系统自主神经的反射性调节,在某种程度上也反映交感-迷走神经的紧张性调节.     

Autonomic nervous system balance, variability and arrhythmia in survivors of myocardial infarction

AIM: To investigate relations between heart rhythm variability (HRV), vegetative balance and electric myocardial activity in myocardial infarction (MI) survivors. MATERIAL AND METHODS: HRV was studied by short 5-min parts of ECG and data of ECG Holter monitoring were analysed for 98 patients who had macrofocal MI 1.5 months to 5 years before. RESULTS: Manifestations of electric heart instability were polymorphic. 69.4% examinees had hyperactivity of the parasympathetic nervous system (PSNS). The influence of the sympathetic nervous system (SNS) increased with growing severity of arrhythmia. Supraventricular arrhythmia occurred more frequently in high PSNS activity, while ventricular arrhythmia occurred more often in SNS prevalence combined with low HRV. CONCLUSION: HRV analysis for MI survivors, especially in combination with Holter ECG monitoring, gives an objective assessment of various manifestations of cardiac dysfunction and therefore enables timely adequate therapy.