135例病人心率变异性分析

目的了解不同疾病、不同性别、不同年龄、不同心脏功能状况时自主神经功能活动的影响。方法对135例诊断明确的病人进行心率变异性(HRV)的时域分析,监测24h全部正常心动周期的标准差(SDDN)、24h每5min正常R-R间期平均值标准差(SDANN)、连续正常R-R间期差值的均方根(r-MSSD)、24h内每5min节段正常R-R间期标准差的平均值(SDNNI)、两个相邻R-R间期标准差>50ms的心搏数占所分析信息间期内心搏数的百分比(PNN50)。结果糖尿病病人HRV下降最明显,尤其是SDDN,SDNNI及PNN50,高血压合并冠心病者SDANN及SDNNI下降,射血分数<50%及年龄≥70岁者HRV明显降低,但各有特点;病人性别对HRV影响无统计学意义。结论不同疾病、不同心脏功能、不同年龄阶段自主神经功能活动有不同特点,HRV测定是判断疾病预后、指导治疗的重要依据。     

儿童心肌炎睡眠期心率变异的观察

目的观察心肌炎患儿夜晚睡眠期心率变异(HRV)的变化,并对变化进行研究。方法随机取我院在2013年3月~2015年3月收治的36例心肌炎患儿,并进行回顾性分析其临床资料,并将36例心肌炎患儿24h的心率检测和睡眠期心率检测与36例正常儿童进行对比,最后将两组心率监测的结果进行分析研究。结果夜晚睡眠心率正常儿童低于心肌炎患儿,但是连续正常R-R间期的标准差正常儿童要高于心肌炎患儿,并且24h的HRV频域和时域指标正常儿童也均高于心肌炎患儿,以上两组儿童的对比,差异显著,均具有统计学意义(P0.05)。结论心肌炎患儿的HRV指标明显低于正常儿童,夜间睡眠期的HRV在排除日间活动及情绪因素后,有着更可靠的结果。     

心率变异性和QT间期变异性与急性心肌梗死患者室性心律失常的关系研究

目的探讨心率变异性(HRV)和QT间期变异性(QTV)与急性心肌梗死(AMI)患者室性心律失常(VA)的关系。方法入选75例在首都医科大学宣武医院心脏科住院的AMI患者,按室性期间收缩Lown's分级对VA进行评估,分为Lown's 1~2级组21例与Lown's 3~5级组54例,同时选择同期健康者50例为正常对照组。对所有受试者进行24 h动态心电图检查,监测室性心律失常、24 h正常R-R间期的标准差(SDNN)、24 h连续5 min正常R-R间期标准差的均值(SDNNindex)、24 h连续5 min正常R-R间期的标准差(SDANNindex)、相邻正常R-R间期差值的均方根(rMSSD)及24 h QT间期。结果与正常对照组比较,AMI组SDNN、SDNNindex、SDANNindex、rMSSD及24 h QTV均明显减小(P均0.05);与Lown's 1~2级组比较,Lown's 3~5级组除r MSSD外,其它SDNN、SDNNindex、SDANNindex及24 h QTV均明显减小(P0.05)。结论 HRV与QTV与心肌梗死后室性心律失常严重程度明显相关。     

基于心功能状态对自主神经功能活动的临床分析

目的分析不同心功能状态下心率变异性(HRV)的变化,探讨心脏功能状况对自主神经功能活动的影响。方法对我院近一年110例病人进行心率变异性时域分析,监测24 h全部正常心动周期标准差(SDDN),24 h每5 min正常R-R间期平均值标准差(SDANN),连续正常R-R间期差值的均方根(RMSSD),24 h内每5 min节段正常R-R间期标准差的平均值(SDNN5),两个相邻R-R间期标准差50 ms的心搏数占所分析信息间期内心搏数的百分比(PNN50)。并以心脏彩超探测出心脏射血分数(EF),分析心率变异性各指标与射血分数的相关性。结果射血分数50%病人HRV中的SDNN,SDNN5,PNN50较EF≥50%病人明显降低,并有一定相关性。而SDNN5,RMSSD等指标无明显变化。结论心衰病人HRV相关指标下降,并与心脏功能状态有一定相关性。HRV与EF测定为判断疾病预后、指导治疗提供了重要依据。     

充血性心力衰竭心率变异性改变及其与心室重塑的关系

目的:检测充血性心力衰竭患者心率变异性(HRV)改变,探讨其与心室重塑的关系。方法:采用Holter检查系统检测了36例CHF患者HRV指标24h正常R-R间期标准差(SDNN)、24h内每5min平均正常R-R间期的标准差(SDANN)24h内每5min的正常R-R间期标准差的平均值(SDNNI),相邻正常R-R间期差值的均方根(rMSSD),相邻正常R-R间期差值≥50ms心搏数占总R-R间期数的百分数(PNN50)及超声心动图指标左心室舒张末期内径(LVEDD),收缩末期内径(LVESD),左心室后壁舒张末期厚度(LVPWT),心室间隔舒张末期厚度(IVST),左心室射血分数(LVEF),左心室舒张早期及舒张晚期充盈速度比值(E/A)及左心室重量指数(LVMI),并以20例健康体检者为对照。结果:CHF患者HRV各时域指标均下降,与对照组相比有显著差异(P<0.05～<0.01)。多元回归分析显示SDNN,SDNNI与LVEDD,LVPWT呈负相关(r=-0.337～-0.362,P<0.05);rMSSD,PNN50与LVEDD,LVESD呈负相关(r=-0.142～-0.433,P<0.05);rMSSD、PNN50与LVEF呈正相关(r=0.387～0.464,P<0.05～<0.001)。结论:CHF患者HRV下降,并与心室重塑有关。     

稳心颗粒对不稳定型心绞痛患者心率变异性的影响

目的观察稳心颗粒对不稳定型心绞痛(UAP)患者心率变异性(HRV)的影响。方法将86例UAP患者随机分为两组,稳心颗粒组及对照组各43例,两组均接受单硝酸异山梨酯缓释片、阿司匹林肠溶片、硫酸氢氯吡格雷片及辛伐他汀片等常规治疗。稳心颗粒组加服稳心颗粒9g,3次/d,共治疗4周,治疗前后行三导联24h动态心电图检查,观察两组患者HRV的时域指标全部正常窦性心搏间期的标准差(SDNN)、窦性心搏间期平均标准差(SDANN)、全程每5minR-R间期标准差的平均值(SDNN Index)、全程相邻R-R间期之差的均方根(rMSSD)、全部R-R间期中相邻R-R间期之差大于50ms心搏数所占比重(PNN50)。结果两组患者治疗后各项HRV指标均明显增高,差异有统计学意义(P<0.05);而稳心颗粒组较对照组升高更显著,差异有统计学意义(P<0.05)。结论UAP患者应用稳心颗粒治疗可改善HRV,对预防心源性猝死及恶性心律失常的发生有积极的作用。     

小儿心肌炎心率变异性分析

目的探讨小儿心肌炎的心率变异性。方法采用ECG-LAB型心电工作站,描记肢体导联采样5min,应用时域及功率谱分析法,通过计算机计算出全部R-R间期的标准差(SDNN)、极低频(vLF)、低频(LF)、高频(HF)。结果以SDNN27ms为阳性诊断标准,将50例小儿心肌炎患者分为两组,SDNN27ms共17例,病情较重;SDNN27ms共33例,病情较轻。两组患儿心电图异常率明显不同(χ2=6.28,P0.05)。心电图的改变与HRV的降低呈正相关。结论重症心肌炎患儿的HRV降低,与心电图的改变正相关。HRV对诊断心肌炎有一定的应用价值。     

老年住院患者心率变异性和24h平均心率的相关性分析

目的分析老年住院患者24 h平均心率与时域指标及频域指标的相关性。方法入选2014年7月~2016年2月于北京市中西医结合医院住院并行动态心电图检查的老年患者187例,回顾性分析动态心电图资料,根据正常R-R间期标准差(SDNN),将研究对象分为心率变异性正常组(A组)91例、中度降低组(B组)66例、重度降低组(C组)30例。频域结果分为下降、正常、升高三个级别,对比分析组间的24 h平均心率、时域和频域参数。结果 SDNN、每5 min R-R间期均值标准差(SDANN)、每5 min正常R-R间期均值标准差(SDNN Index)、相邻正常R-R间期差值均方根值(RMSSD)、相邻正常R-R间期50 ms计数占总R-R间期数的百分比(PNN50)、白天SDNN、夜间SDNN、总的频域值(TP)在A、B、C三组间呈降低趋势(组间比较,P均0.01)。24 h平均心率在A、B、C三组间呈升高趋势(组间比较,P均0.01)。A组低频成分(LF)正常比率明显高于B、C组,差异有统计学意义(P0.01);B、C组中LF下降患者所占比率最高。A组高频成分(HF)升高患者所占比率最高,B、C组HF下降患者所占比率最高。HF下降比率,三组间两两比较,C组高于B组高于A组,差异均有统计学意义。SDNN与24 h平均心率呈负相关,γs=-0.42(P0.01)。SDNN与TP呈正相关,γs=0.56(P0.01)。结论老年住院患者SDNN与24 h平均心率呈负相关,与TP呈正相关。     

血液透析治疗尿毒症者心率变异性与心律失常关系的探讨

目的分析血液透析(HDL)治疗尿毒症者的心律失常与心率变异性(HRV)的特点。方法对40例HDL者(A组)及50例健康对照者(B组)进行动态心电图(DCG)监测,对心律失常发生情况及HRV各项指标:24h内全部正常R-R间距标准差(SDNN),24h每5min窦性R-R间距平均值的标准差(SDANN),24h每5min窦性R-R间距平均值的标准差的均值(SDNN index),两个相邻窦性R-R间距互差>50ms的心跳数占所分析信息间期内心搏数的百分比(PNN50),相邻窦性R-R间距差值的均方根(RMSSD)进行对比分析。结果尿毒症者的心律失常(房性心律失常及室性早搏)的发生率明显高于B组,HRV各项指标与B组比较有显著差异性(P<0.01)。结论 HRV明显降低,心律失常发生率高,提示尿毒症者自主神经功能受损。     

合并室性心律失常的心力衰竭患者心率变异性和心功能变化及其关系

目的分析合并室性心律失常的心力衰竭患者心率变异性(heart rate variability,HRV)变化及其与心功能的关系。方法选取2018年2月至2020年2月江阴市人民医院收治的105例心力衰竭患者为研究对象,根据有无偶发室性期前收缩(室早)分为观察组(n=55)和对照组(n=50),检测两组患者的HRV和心功能,并分析HRV和心功能的相关性。结果观察组患者24 h内R-R间期标准差(standard deviation of R-R interval within24 h,SDNN)、24 h内每5 min节段R-R间期平均标准差(mean standard deviation of R-R interval per 5 min segment within 24 h,SDANN)、24 h内每5 min节段R-R间期均值标准差(standard deviation of mean R-R interval per5 min segment within 24 h,ASDNN)、相邻正常R-R间期标准差(adjacent normal R-R interval standard deviation,rMSSD)及相邻正常心动周期≥50 ms的R-R间期差值构成比(composition ratio of R-R interval difference between adjacent normal cardiac cycles≥50 ms,PNN50)均低于对照组,差异有统计学意义(P0.05)。对照组患者睡眠状态时SDNN、SDANN、ASDNN、r MSSD及PNN50均高于清醒状态,差异有统计学意义(P0.05);观察组患者睡眠状态和清醒状态时的SDNN、SDANN、ASDNN、r MSSD及PNN50比较,差异无统计意义(P0.05)。观察组患者左心室射血分数(left ventricular ejection fraction,LVEF)、二尖瓣心室充盈早期血流速度峰值(E峰)和晚期心室充盈心房收缩血流速度峰值(A峰)的比值(E/A)低于对照组,左心室舒张末期内径(left ventricular end diastolic dimension,LVEDD)、左心房内径(left atrial diameter,LAD)高于对照组,差异有统计学意义(P0.05)。Spearman相关分析显示,SDNN、SDANN、ASDNN、rMSSD与LVEF、E/A呈正相关,与LVEDD、LAD呈负相关(P0.05)。结论心力衰竭合并室性心律失常患者HRV呈低表达,且与心功能具有相关性。     

健康儿童心率变异性长程时域指标的

目的探讨健康儿童心率变异性(HRV)长程时域指标的特点。方法对266例健康儿童HRV24小时长程时域指标（SCL、SDNN、SDNNindex、SDANN、RMSSD、三角指数）进行不同年龄、性别及与成人正常参考值间进行分析比较。结果①儿童不同性别组间HRV差异无显著性;②儿童不同年龄组间虽心动周期（或心率）存在差异,但HRV差异无显著性;③儿童组与成人正常参考值中SDNN、SDANN、RMSSD存在有差异显著性,RMSSD在儿童中明显高于成人组。结论SDANN、SDNNindex是反映交感神经功能的敏感指标,而RMSSD更能反映迷走神经功能,可见儿童的自主神经功能较成人活跃,而随着年龄的增长即自主神经功能的减退,尤其是迷走神经的紧张性抑制功能明显减退。     

Prognostic value of heart rate turbulence and heart rate variability in children with dilated cardiomyopathy

The aim of our study is to evaluate the prognostic value of heart rate turbulence and heart rate variability in children with dilated cardiomyopathy (DCM). Twenty-five children with DCM and 24 age- and sex-matched healthy children who were admitted between January 2002 and September 2004, enrolled in this prospective study at our hospital. After the echocardiographic examination, three-channel 24-ambulatory ECG recordings were obtained in all patients with DCM and in the control group. Time domain heart rate variability parameters were obtained in both groups. Heart rate turbulence was measured in DCM patients, but we could not calculate heart rate turbulence in the control group since no ventricular ventricular premature complexes (PVC) were found in the 24-hour ECG monitoring in the control group. The mean follow-up period of the DCM group was 13.4 months (3-26 months). Five patients died (20%) during the follow-up period. Triangle index, turbulence slope (TS), age and availability of nonsustained ventricular tachycardia (VT) on 24-hour ECG monitoring were prognostic factors according to the correlation analyses. Only triangle index was detected as an independent risk factor among the prognostic factors according to the logistic regression analyses. This study assessed the prognostic value of heart rate turbulence and heart rate variability in children with dilated cardiomyopathy. Further studies are needed to investigate the prognostic value of heart rate turbulence.     

Effect of age on mean heart rate and heart rate variability

Age-related changes in heart rate and in its variability might prove to be a suitable parameter to evaluate the physiological course of advancing age in human beings. We demonstrated higher mean heart rate values and increased heart rate variability in younger adult subjects. A significant direct relationship was demonstrated by linear regression equation between age and the product between mean heart rate and heart rate variability. We conclude that the analysis of these parameters may help assess the aging process of human beings.     

Heart rate and haemodynamics after autonomic blockade in infants and children

In order to assess the role of the autonomic system in the age differences in heart rate, propranolol 0.2 mg./kg. and atropine 30 micrograms/kg. were given to 103 infants and children during the course of heart catheterization. Mean control minute heart rate varied from 118 at age 1 year to 81 at age 16 years. Heart rate after drugs was termed intrinsic heart rate after Jose, and the mean varied from 139 at age 1 to 102 at age 16 years. After propranolol alone, mean heart rate was 120 at age 1, 71 at age 16, and after atropine corresponding rates were 162 and 128. The scatter in predicting heart rate from age was not lessened by autonomic blockade, suggesting that inter-individual variations in heart rate are not entirely dependent on different levels of autonomic function. The inverse relation between heart rate and age persisted after autonomic blockade, indicating that different levels of autonomic function are not responsible for the age differences in heart rate. The most important determinant of the heart rate after blockade was the initial control heart rate. Increases in cardiac index followed autonomic blockade in patients over 4 years of age and in patients without intracardiac shunts, while stroke index decreased, and femoral artery pressure increased 2/7 mm. Hg.     

Hemodynamic impacts of entrainment of heart rate and stride rate

Synchronization of heart rate and step rate has been hypothesized to create a hemodynamically favorable situation where heart motion and bodily motion are in constant harmony so that stroke volume and cardiac output enhanced and oxygen delivery to the tissues is increased. The primary aim of the present investigation was to determine the impact of synchronization of step rate and heart rate on cardiovascular functions. Twenty-three apparently healthy subjects performed treadmill running in three different conditions, one that the step rate was matched with the heart rate (matched condition), one that the step rate was ～10 steps greater or lower than heart rate (unmatched conditions). Beat-by-beat blood pressure was measured using the finger plethysmography, and stroke volume and cardiac output were calculated using the validated Model Flow method. Average heart rate and blood pressures were not different among the 3 conditions. There were no differences in double products among the 3 conditions. Stroke volume and cardiac output were greater (P < 0.05) in the matched condition than in the unmatched conditions. Our present results are consistent with the idea that synchronization of heart motion and bodily motion augments stroke volume and cardiac output, presumably through the mechanism similar to the arterial counterpulsation.     

Heart rate and haemodynamics after autonomic blockade in infants and children.

In order to assess the role of the autonomic system in the age differences in heart rate, propranolol 0.2 mg./kg. and atropine 30 micrograms/kg. were given to 103 infants and children during the course of heart catheterization. Mean control minute heart rate varied from 118 at age 1 year to 81 at age 16 years. Heart rate after drugs was termed intrinsic heart rate after Jose, and the mean varied from 139 at age 1 to 102 at age 16 years. After propranolol alone, mean heart rate was 120 at age 1, 71 at age 16, and after atropine corresponding rates were 162 and 128. The scatter in predicting heart rate from age was not lessened by autonomic blockade, suggesting that inter-individual variations in heart rate are not entirely dependent on different levels of autonomic function. The inverse relation between heart rate and age persisted after autonomic blockade, indicating that different levels of autonomic function are not responsible for the age differences in heart rate. The most important determinant of the heart rate after blockade was the initial control heart rate. Increases in cardiac index followed autonomic blockade in patients over 4 years of age and in patients without intracardiac shunts, while stroke index decreased, and femoral artery pressure increased 2/7 mm. Hg.     

The heart rate of Romano-Ward syndrome patients

The Romano-Ward prolonged QT syndrome is associated with an abnormality of ventricular recovery, rendering the patients susceptible to life-threatening ventricular arrhythmias. The pathophysiology has not been clearly defined. It has been proposed that the syndrome involves disparity of right and left cardiac sympathetic activity, with the left side dominant. This could be the result of left-sided overactivity or right underactivity. The right-sided nerves contain the chronotropic fibers, which affect heart rate. A deficiency of the effect of the right-sided nerves might, therefore, be manifest by slower heart rates. To examine this possibility, the resting heart rates of 58 Romano-Ward syndrome patients were compared to those of 255 age-matched normal controls. A significant difference in resting heart rate was observed between the Romano-Ward syndrome patients and the normal controls in newborns and children up through age 3 years. No difference was present in older children or in adults. The data are consistent with right-sided sympathetic deficiency manifest by a slower heart rate at birth and during early years of life, when sympathetic tone is high and contributes to resting heart rate, but not in older children or in adults in whom resting heart rate is principally under parasympathetic control.     

Effect of age related changes in chamber size, wall thickness, and heart rate on left ventricular function in normal children.

We assessed the effects of age related changes in chamber size, wall thickness, and heart rate of left ventricular function in 78 normal children, aged 1 1/2 to 12 1/2 years, using computer analysis of their left ventricular echocardiograms. Left ventricular cavity size and wall thickness increased linearly with age. Left ventricular fractional shortening, percentage of wall thickening, and the ratio of end-diastolic wall thickness to cavity radius (H/R ratio) did not change with age. Peak Vcf correlated with heart rate and the decrease in heart rate with age resulted in the progressive fall in peak Vcf, while peak rate of left ventricular was thickening remained constant. The peak rate of increase in left ventricular cavity dimension in early diastole varied inversely with heart rate, but independently of cavity size, increasing throughout childhood. The peak rate of wall thinning also increased with age, correlating with wall thickness and not heart rate. Thus, age related increases in left ventricular cavity dimension and wall thickness during the rapid growth period of childhood occurred in such a way that left ventricular architecture (H/R ratio) remained unchanged. This may account for the constancy of regional and cavity systolic function. The greater dependence of diastolic cavity function on heart rate may be explained by the disproportionately greater effect of cardiac cycle length on the duration of diastole and systole.     

健康人群心率分布的初步调查研究

目的探讨健康人心率分布的基本特点,以及与年龄、性别的关系,为频率适应性起搏器的程控提供依据。方法通过常规Holter收集数据,对不同年龄和性别的90名健康人日常活动下的平均心率、最大窦性心率和高频心率分布（〉90,100和110次/min）进行比较。结果①中年组、老年组之间平均心率差异无统计学意义（P〉0.05）;中年组、老年组之间最大窦性心率差异无统计学意义（P〉0.05）;各组男女之间平均心率和最大心率差异无统计学意义（P〉0.05）;②中年组与老年组之间高频心率分布差异有统计学意义（P〈0.05）。结论随着年龄上升,心脏的变时能力有减退趋势;健康人心脏变时能力与性别没有关系。     

Effect of posture on heart rate variability spectral measures in children and young adults with heart disease

BACKGROUND: Reduction of heart rate variability as a consequence of heart disease and postural change has been well documented. However, the data on the effect of postural change in pediatric patients are incomplete and the effect is not fully understood. The aim of the study was to investigate effect of postural change on heart rate variability in relation to the extent of severity of heart disease. METHODS: The dependence of heart rate variability on posture in 41 children and young adults (8-20 years) with heart disease has been investigated and compared with control. Short-term electrocardiograms (ECGs) were assessed in supine rest and active standing, and spectral measures of heart rate variability were determined. RESULTS: Two types of response to the change of supine to standing posture were determined in both healthy and diseased subjects. In majority of subjects, the increased heart rate induced by standing was accompanied by a decrease in high-frequency power. However, in about 30% of all subjects, increased heart rate during standing was accompanied by an increased high-frequency power. Independently of posture and disease, high-frequency and low-frequency power were positively correlated. In subjects characterized by a reduction of heart rate variability in standing, the high-frequency power in both postures is reduced in diseased subjects compared to control. CONCLUSIONS: These results demonstrate that in this age range, the response to posture is not unique because of the difference in high-frequency power, which implies a variety of vagal modulations of heart rate.