慢性心衰患者不同时间心率变异性与短阵室速的相关性研究

目的]通过延长(72 h)动态心电图监测慢性心衰患者心率变异性(HRV)与非持续性室速(NSVT)并分析其相关性.方法]选择2016年3月至2016年9月湖南省人民医院老年病科收治的80例慢性心衰患者,对其行连续72 h动态心电图监测,根据是否检出NSVT将其分为NSVT组(n=30)和无NSVT组(n=50),分析组间HRV指标的差异及NSVT与24 h、48 h、72 h的HRV指标间的相关性.结果]NSVT组中各项时域指标均低于无NSVT组,但两组间仅24 h内全部窦性R-R间期的标准差(SDNN)比较,差异具有统计学差异(P＜0.01);两组频域指标极低频功率(VLF)、低频功率(LF)、高频功率(HF)比较,差异均无统计学意义(均P＞0.05),NSVT组LF/HF显著高于无NSVT组,差异具有统计学意义(P＜0.05).HRV中的各项时域及频域指标在24 h、72 h仅SDNN、LF/HF与NVST显著相关,48 h时SDNN、全程相邻RR间期之差的平方根(rMSSD)、相邻RR间期相差＞50 ms的个数占总心跳数的百分比(PNN50)、LF/HF与NVST显著相关性,仅48 h中SDNN与NSVT成中等程度相关,其余指标与NSVT成低度相关.随着心衰程度的加重,NSVT的检出率呈升高的趋势,而SDNN均值则随之降低,NYHA心功能Ⅱ级、Ⅲ级、Ⅳ级组间比较差异均有统计学意义(P＜0.01).结论]通过72 h动态心电图监测发现慢性心衰患者的HRV与NSVT有一定的相关性,SDNN降低及LF/HF升高可作为NSVT的预测因子,从而进一步判断心衰患者的预后.

Correlation Study between Heart Rate Variability and Short Ventricular Tachycardia in Patients with Chronic Heart Failure

Objective]To monitor heart rate variability (HRV) and non sustained ventricular tachycardia (NSVT) in patients with chronic heart failure (CHF) by by prolonged Holter(72h) and analyze their correlation.Methods]The clinical data of 80 patients with chronic heart failure admitted to Hunan Peoplés Hospital from March 2016 to September 2016 were selected,and their continuous 72h dynamic electrocardiogram was monitored,and they were divided into NSVT group (n =30) and no NSVT group according to whether NSVT was detected;the differences between the HRV indicators,and correlation between NSVT and HRV indexes at 24 h,48 h,72 h were analyzed.Results]The time domain indexes in the SVT group were lower than those without NSVT group,but the difference of only 24 h standard deviation (SDNN) of all sinus R-R interval of the two groups was statistically significant (P ＜0.01);There was no significant difference between the two groups in the low frequency power (VLF),low frequency power (LF) and high frequency power (HF) in the frequency domain(mean P ＞0.05),NSVT in the group LF/HF was significantly higher than that in the NSVT group,the difference was statistically significant (P ＜0.05).The time domain and frequency domain indexes of HRV were significantly correlated with SDNN,LF/HF and NVST at 24 h and 72 h,respectively;48 h SDNN,root mean square of successive differences (RMSSD),PNN50 and LF/HF were significantly corelated with NSVT;SDNN and NSVT were only moderately correlated with NSVT in 48 h,Other indicators were associated with NSVT lowly.With the aggravation of heart failure,the detection rate of NSVT showed an increasing trend,and the SDNN value was de creased,the difference of NYHA cardiac function grade Ⅱ,Ⅲ and Ⅳ was statistically significant (P ＜0.01).Conclusion] HRV is correlated with NSVT in CHF patients by 72h Holter,and the decrease of SDNN and the increase of LF/HF can be predictors of NSVT to evaluate the prognosis of patients with heart failure.