窦性心率震荡检测方法学重复性和稳定性研究

目的从方法学角度,探讨窦性心率震荡(HRT)检测的重复性及稳定性。方法入选60例健康人,连续记录48h动态心电图,观察长程HRT和短程四个时段HRT(白天、夜晚、凌晨、清晨)的震荡初始(TO)、震荡斜率(TS)、震荡离散度(TD)连续两天的数值及其相关性,以及24h内HRT动态变化特点。结果长程TO、TS、TD各指标连续2天的数值间具有显著相关性(r值分别为0.807,0.796,0.791;P均(0.01)。短程TO、TS、TD首日白天、夜晚、凌晨、清晨各时段与次日对应时段间数值重复检测相关程度亦较高(TO的r值分别为0.634,0.562,0.398,0.502;TS的为0.553,0.660,0.598,0.600;TD的为0.451,0.551,0.487,0.481;P均(0.01)。TS、TD显示出白天最低,入睡前逐渐升高,至凌晨达全天最大,于清晨下降的较弱的昼低夜高动态演变,而TO在一天中则相对平稳。结论长程与短程HRT检测均具有较好重复性。HRT是一个稳定的、可靠的、科学的反映自主神经活性的临床指标。HRT可能存在一定的昼夜节律性,动态观察HRT更具临床价值。

Methodology research on repeatability and stability of heart rate turbulence detection

Objective To discuss the repeatability and stability of heart rate turbulence （HRT） from methodology. Methods Sixty healthy people were selected, dynamic electrocardiogram of 48 h was continuously recorded, the value and correlation for two continuous days of turbulence onset （TO）, turbulence slope （TS） and turbulence dynamicity （TD） of long-range HRT and short-range four time periods （daytime, night, wee hours and early morning）, and HRT dynamic change characteristics in 24 h were observed. Results The value of every index of long-range TO, TS and TD for two continuous days had prominent correlation （r value was respectively 0.807, 0.796 and 0.791, P 〈 0.01 ）. The value re- peated detection relative degree of each time period of daytime, night, wee hours and early morning of short-range TO, TS and TD in the first days and corresponding time periods of the second day was also higher （ The r value of TO was 0.634, 0. 562,0. 398 ,0. 502 respectively; The r value of TS was 0.553,0. 660,0.598 and 0.600 respectively, TD was 0.451,0. 551,0.487 and 0.481, P 〈 0.01 ）. TS and TD displayed the weaker dynamic evolution of lowering in daytime and increasing in night, namely, the value was the lowest in daytime, was increased gradually before sleeping, reached the maximum of the whole day in wee hours, and was lowered in early morning, but TO was relatively stable in one day. Conclusions Both short-range and long-range HRT detection has better repeatability. HRT is a clinic index for reflecting autonomic nervous activity stably, reliably and scientifically. Maybe HRT has certain circadian rhythm, dynamic observation of HRT has more clinical value. Chinese Journal of Cardiac Pacing and Electrophysiology,2010,24（4） ：333 - 336 ]