急性心肌梗死早期溶栓治疗对HRV和QTd的影响

早期溶栓治疗能显著下降急性心机梗死患者的住院死亡率 ,远期预后也显著改善[1 ] ,已成为急性心机梗死的最有效治疗方法。但早期溶栓治疗能否提高心率变异性 (HRV) ,减少QT间期离散度 (QTd) ,从而提高副交感神经张力 ,改善急性心机梗死中植物神经对心血管调节的不平衡状态 ,并减轻心室复极时的不匀齐性[2 ,3] ,目前报道尚不多 ,作者就此探讨如下。1　资料与方法1 996年 9月～ 2 0 0 1年 1 2月本院内科共收治确诊为急性心机梗死患者 2 60例 ,其中符合以下条件的 1 5 8例纳入本研究组 :①首次Q波型心机梗死 ;②测定HRV及QTd时无电解质紊…     

Decreased R-R variation: A criterium for overdosage of tricyclic psychotropic drugs

Objective Since intoxication with tricyclic antidepressants is common, a supplementary screening method for differentiation between therapeutic and supratherapeutic ranges would be a valuable diagnositc tool, particularly in delirious and unconscious patientsSetting 109 patients treated with amitriptyline, 8 patients treated with doxepin, 10 patients treated with clozapine, and 72 normal control subjects matched for age and sex were tested for heart rate variability while resting.Results Considering time and frequency derived measures, which are rather independent of heart rate, the patients showed significantly decreased heart rate variability parameters (p<0.0001), as compared with the normal subjects. Of the patients presenting delirious symptoms 6 showed coefficients of variation more than 4 standard deviations below the mean control value.Conclusions As heart rate variability can be easily calculated, this measurement is suggested as a useful tool to quickly exclude or support the diagnosis of chronic intoxication with tricyclic antidepressants or clozapine.     

我国正常中老年人心率变异分析

心率变异分析（ＨｅａｒｔｒａｔｅｖａｒｉａｂｉｌｉｔｙＨＲＶ）目前被认为是一项预测心性猝死，特别是预测心肌梗死后病人猝死危险性的独立、敏感的指示。目前尚缺乏大样本ＨＲＶ时相分析正常值范围。本研究采用英国ＯＸＦＯＲＤ公司ＭｅｄｉｌｏｇＥＸＣＥＬ长程心电图分析系统，分别用标准差法（Ｓｔａｎｄａｒｄｄｅｖｉａｔｉｏｎ，ＳＤ）和ＨＲＶ指数法（ＨＲＶＩｎｄｅｘ）对１２０名（男：女＝９７：２３）４０一７０岁（平均５７岁，＜６０岁者６６人，≥６０岁者５４人）健康人的２４小时ＨＲＶ值进行测算。其结果为，ＳＤ：１１８．１５±１５．３７ｍｓ．ＨＲＶＩｎｄｅｘ１８．６２±２．３１；中年组（＜６０岁）平均ＳＤ：；１２２．０３ｍｓ．平均ＨＲＶＩｎｄｅｘ：２０．１６；老年组（≥６０岁）平均ＳＤ：１０７。９２ｍｓ．平均ＨＲＶＩｎｄｅｘ：１６．４１。两种方法的结果均显示。ＨＲＶ日间低于夜间，中年人高于老年人，３小时９时ＨＲＶ最低，与晨间冠心病急性发作事件高峰相吻合。本文并对ＨＲＶ的昼夜变化规律及其意义进行了初步探讨。     

HRV的最大李雅普诺夫指数估计

对心率变异性(HRV)进行了研究,比较了心率正常者与心率失常者HRV之间的最大李雅普诺夫指数上的差别。人在正常状态和病理状态下的HRV信号最大李雅普诺夫指数是不同的,当出现病理心血管事件时,指数α减少,因此李雅普诺夫指数可作为人体是否异常或处于何种异常状态的特征刻画指标,本文心率正常者HRV信号的最大李雅普诺夫指数为0.45907,心率不齐者的最大李雅普诺夫指数是0.41472。它们均为混沌信号,但是处于心率不齐状态的节律混沌程度明显比处于心率正常状态的节律混沌程度低。     

无症状心肌缺血心率变异性分析

目的:探讨无症状心肌缺血的昼夜节律变化与心脏自主神经的关系。方法:对无症状心肌缺血者及健康者均进行24小时动态心电监护,从而分析其心率变异性(HRV)。结果:无症状心肌缺血组的HRV较正常对照组的HRV明显下降(P<0.05);无症状心肌缺血组其白天的HRV较夜间下降更低,存在明显的昼夜节律变化(P<0.05)。结论:无症状心肌缺血的发生与交感神经活性增强、迷走神经活性减低有关,自主神经受损是无症状心肌缺血的一个重要因素。     

职业女性经前期综合征心理干预效果评价

[目的]探讨对经前期综合征（PMS）患者进行心理干预的效果。[方法]对2004年11月至2005年10月在大同市第七人民医院体检的253名有PMS表现的职业女性进行调查。[结果]心理干预后症状自评量表（SCL-90）各因子均分中，恐惧因子无变化，其他各因子均分均有下降（P〈0．05或〈0．01）；心率变异频域分析，心理干预后与干预前比较，TP增加（P〈0．01）、LF／HF下降（P〈0．05）。[结论]对PMS患者进行心理干预可以调整其心理状态，使交感神经、迷走神经趋于平衡。     

美托洛尔缓释片对原发性高血压患者心率变异性的影响

目的:研究美托洛尔缓释片对原发性高血压患者心率变异性的影响。方法:94例原发性高血压患者,洗脱2周后,随机口服富马酸美托洛尔缓释片(95 mg.d-1,qd)或酒石酸美托洛尔缓释片(100 mg.d-1,qd)8周。服药前和药后8周行24 h动态心电图检查各1次,分析2组及全部患者的24 h时域和5 min频域指标。结果:2组患者药前、药后的长程时域指标和短程频域指标组间比较均无统计学差异。94例全部患者药前/药后24 h平均心率为(76.27±8.18)/(69.29±6.48)次.min-1(P<0.000 1),药后长程时域指标PNN50显著增加(5.6±4.8)ms vs(8.5±7.2)ms(P<0.000 1);短程频域指标HF增加(88.8±92.8)Hz vs(127.3±127.1)Hz(P=0.007),LF/HF明显下降(2.9±2.0)vs(2.1±2.1)(P=0.002)。结论:美托洛尔缓释片有益于原发性高血压患者心率变异性的恢复,2种不同酸根美托洛尔缓释片的作用无明显差异。     

围绝经期综合征患者心率变异性与中医辨证分型关系的探索

目的研究心率变异性(HRV)与围绝经期综合征中医辨证分型的关系,探索中医证的客观化。方法通过对87例围绝经期综合征患者与32例正常对照组HRV的频域分析,观察、分析肝肾阴虚型、阴虚阳亢型、气阴两虚型围绝经期综合征与正常对照组HRV各指标的差异。结果围绝经期综合征患者三型之间TP、VLF、LF的差异显著,总的趋势从肝肾阴虚型、阴虚阳亢型、气阴两虚型依次降低(P<0.05,P<0.01);气阴两虚型较其他两型TP、VLF、LF、HF、LF/HF比值、VLF/HF比值、SD、LFnorm降低,HF、HFnorm升高,差异显著(P<0.05,P<0.01);肝肾阴虚型与正常对照组间HRV差异不显著(P>0.05);结论HRV的部分指标可能为围绝经期综合征中医辨证分型的客观化提供参考。     

Exploring the effectiveness of a specialized therapy programme for burnout using subjective report and biomarkers of stress

The increasing prevalence of stress-related disorders such as burnout urges the need for specialized treatment approaches. Programmes combining psychotherapy and regenerative interventions emerge to be the most successful. However, evaluated therapy programmes are scarce and usually involve subjective symptom quantification without consideration of physiologic parameters. The aim of the present exploratory, single-group study was the multimodal investigation of the effectiveness of a specialized holistic therapy programme by assessing symptoms and biological markers of chronic stress. Seventy-one in-patients (39 men/32 women; age 46.8 ± 9.9 years) of a specialized burnout ward with the additional diagnosis of burnout (Z73.0) in conjunction with a main diagnosis of depressive disorder (F32 or F33) according to the International Classification of Diseases (ICD)-10 were included in the study. In addition to symptomatology, the stress-responsive biomarkers heart rate variability (HRV) and serum brain-derived neurotrophic factor (BDNF) were measured in patients at admittance to and discharge from the burnout ward applying a 6-week specialized treatment programme. At discharge, patients showed a significant reduction of symptom burden and a significant increase in serum BDNF, while HRV remained unchanged. The findings implicate that the therapy programme may have beneficial effects on symptomatology and neuroplasticity of patients with burnout. As therapy was often supplemented by psychopharmacological treatment, a relevant influence of antidepressant medication especially on BDNF has to be considered.     

Detection of multiple viral and bacterial infections in acute exacerbation of chronic obstructive pulmonary disease: A pilot prospective study

Few studies have evaluated the contribution of multiple virus and bacterial infections in acute exacerbation of chronic obstructive pulmonary disease. This study estimated the burden of multiple viral and bacterial respiratory infections in moderate to very severe chronic obstructive pulmonary disease patients that were prospectively followed‐up during a 12‐month pilot study. Clinical data were collected monthly and sputum was collected at the time of each acute exacerbation event. Classical culture techniques for bacteria and multiplex polymerase chain reaction (PCR) and microarray detection assays were performed to identify viral and atypical bacterial pathogens in the sputum. Overall, 51 patients were included and 45 acute exacerbation events were investigated clinically and microbiologically. Among the 45 acute exacerbation events, 44% had evidence of viral infection involving human rhinovirus (HRV) and metapneumovirus (hMPV) in 20% and 18%, respectively. Intracellular bacteria were not found in sputum by PCR. Common bacterial pathogens were identified in 42% of acute exacerbation patients, most frequently Branhamella catarrhalis, Streptococcus pneumoniae and Haemophilus influenzae. Viral or virus and bacteria co‐infections were detected in 27% of acute exacerbation events (n = 12) with HRV and hMPV involved in 92% of cases. Patients with co‐infections did not present greater clinical severity scores at exacerbation and more recurrence of acute exacerbation events at 3 and 6 months than those with single infections (P > 0.4). These results suggest that HRV and hMPV may be contributors or cofactors of AECOPD. These findings indicate that viral or virus and bacterial co‐infections do not impact significantly on the clinical severity of acute exacerbation of chronic obstructive pulmonary disease and recurrence at 3 and 6 months. J. Med. Virol. 85:866–873, 2013. © 2013 Wiley Periodicals, Inc.