冠心病、糖尿病和高血压患者心率变异性特点及其机制的初步探讨

目的探讨冠心病、糖尿病和高血压患者自主神经功能活动的特点及其意义。方法收集我院2010年10月至2012年5月住院的135例诊断明确的冠心病、糖尿病、高血压患者进行心率变异性（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），24h内每5min节段正常R—R间期标准差的平均值连续正常R—R间期差值的均方根（RMSSD），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）。结果糖尿病患者HRV下降最明显，尤其是SDDN、SDNN5及PNN50三项；高血压合并冠心病患者SDANN及SDNN5下降。射血分数〈50％及年龄≥70岁者HRV明显降低。患者性别间无差异性。结论不同疾病，不同心脏功能，不同年龄阶段心脏自主神经功能活动有不同特点，与其自身的发病机理有内在关系。HRV测定可为判断疾病预后、指导治疗提供重要依据。

The character and preliminary mechanism analysis of heart rate variability in coronary heart disease, diabetes mellitus and hypertension

Objective Explore the functional character and significance of autonomic nervous system in coronary heart disease （CHD）, diabetes mellitus （DM） and essential hypertension （EH） and in different sex, different ages, different left ventrieular ejection fraction （LVEF）. Methods The time domain of heart rate variability （HRV） was analyzed in 135 patients who were diagnosed definitely. All data were analyzed with SPSS. Results HRV in patients with diabetes mellitus was reduced most significantly, especially in SDDN, SDNN5 and PNN50. SDANN and SDNN5 in patients with CHD complicated by ET was reduced. HRV in patients with EF be- low 50% was obviously reduced. So was in patients over 70 years. There was no difference between male and fe- male. Conclusion There are different functional character of autonomic nervous system in different disease, so are in different ejection fraction and different age. There are intrinsic links of original mechanism among these diseases HRV is an important implement in assessing prognose and guiding treatment.