脑梗死后心率变异的常见临床因素分析

目的 研究脑梗死患者心率变异性(HRV)的特点及其影响因素,为脑梗死的治疗提供有意义的借鉴.方法 研究梅州市人民医院神经内科自2007年5月至2009年6月收治、经CT或MRI检查确诊的190例脑梗死患者的临床资料,以同期健康体检者50例做为对照,利用24 hHRV分析技术测定并比较心脏自主神经活性受损程度,再按照脑梗死患者的年龄、性别、梗死类型、病情程度、预后、梗死部位对病例进行分组并分析上述因素对患者HRV的影响.结果 脑梗死组患者HRV相关指标均低于对照组;≥60岁组患者HRV各项指标低于<60岁组;除总功率谱(TF)外,女性HRV指标均低于男性,腔隙性梗死患者HRV指标高于动脉粥样硬化性腩梗死和脑栓塞患者,GCS评分较低的患者HRV指标较低,预后为死亡的患者HRV指标最低,其次为好转、治愈患者.右岛叶梗死患者HRV时域指标低于其他梗死部位患者,差异均有统计学意义(P<0.05).结论 脑梗死患者自主神经系统失衡,早期动态监测HRV可以判断脑梗死患者脑功能损伤程度及病情演变趋势,有助于早期识别高危患者,指导临床治疗.

Common clinical factor analysis of heart rate variability in patients with cerebral infarction

Objective To explore the characteristics of heart rate variability (HRV) and its impact factors in patients with cerebral infarction and provide evidence for treatment of cerebral infarction. Methods The clinical data of 190 patients with cerebral infarction were analyzed. These patients admitted to our hospital from May 2007 to June 2009 and CT or MRI confirmed their diagnoses. Fifty healthy subjects in the same period were chosen as control group. The 24 h HRV analysis technology was employed to compare the activity impairment of their cardiac autonomic nervous. According to age, gender, type of infarction, infarct location, severity and prognosis, patients with cerebral infarction were divided into several subgroups; the impact of these factors on patients with HRV was analyzed. Results HRV indexes in patients with cerebral infarction were lower than those in the control group (P<0.05). Patients that were older than or equal to 60-year-old showed lower HRV indexes as compared with the patients that were younger than 60-year-old (P<0.05). Except for the temporal frequency, the other HRV indexes satisfied the following conditions: lower HRV indexes in female were showed as compared with those in male (P<0.05); the HRV indexes in patients with lacunar infarction were significantly higher than those in patients with atherosclerotic cerebral infarction or cerebral embolism (P<0.05); patients with right insula infarction showed significantly lower time domain HRV indexes than patients with other position infarction (P<0.05); HRV indexes were low in patients with low GCS scores. The lowest HRV indexes were noted in patients with the incidence of death, followed by patients with improvement and cured patients. Conclusion Autonomic nervous system in patients with cerebral infarction is overbalanced. Early dynamic monitoring of HRV can determine the extent of brain injury and the evolution of the disease, contributing to early identification of high risk patients and guiding the clinical treatment.