不同部位脑梗死对心脏自主神经功能的影响  

Localization of ischemic stroke may have different effects on autonomic function

作　　者：刘宏鸣[1] 樊济海[1] 刘晓英[1] 顾秀莲[1] 卢静[1] 李亚维[1] 王玲[1] 彭华[1] 

机构地区：[1]解放军第455医院心内科,上海200052

出　　处：《第二军医大学学报》2004年第9期994-996,共3页Academic Journal of Second Military Medical University

基　　金：.NULL.

摘　　要：目的 :通过测定心率变异性 (heart rate variability,HRV)参数观察不同部位脑梗死对心脏自主神经功能的影响。 方法 :对经 CT和 MRI证实的 10 8例脑梗死患者 [男 6 2例 ,女 4 6例 ,平均年龄 (6 6 .5± 10 .1)岁 ]和 70例健康志愿者 [男 4 2例 ,女 2 8例 ,平均年龄 (6 4 .8± 11.7)岁 ]的 HRV各指标进行分析 ,包括 SDNN(2 4 h内全部窦性 R- R周期的标准差 )、SDANN (2 4h内每 5 min节段窦性 R- R周期平均值的标准差 )、SDNNIndex(2 4 h内每 5 m in窦性 R- R周期标准差的平均值 )、RMSSD(2 4 h内全部窦性 R- R周期差值的均方根 )、PNN50 (2 4 h内相邻两正常窦性 R- R周期差值大于 5 0 m s的个数所占的百分数 )以及HRVTI(心率变异三角指数 )。将脑梗死组分为 :半球梗死组 (73例 ,左侧组 35例 ,右侧组 38例 )、脑干梗死组 (35例 ,延髓组 17例、桥脑组 10例和中脑组 8例 ) ,并分别进行比较。结果 :脑梗死组及半球梗死、脑干梗死的 HRV各参数与对照组比较均显著降低 (P<0 .0 5 )。对半球左、右两侧梗死进行比较 ,右侧各参数在半球中最低。延髓各指标均低于对照组 ,SDNN、RMSSD、PNN50 显著低于桥脑和中脑 ;桥脑和中脑的 SDANN、SDNNIndex与延髓组比显著降低 (P<0 .0 5 )。 结论Objective:To demonstrate the effects of different ischemic stroke localization on autonomic function parameters assessed by heart rate variability(HRV). Methods: Totally 108 patients with ischemic stroke (62 male and 46 female, mean age 66.5±10.1 years) and 70 healthy volunteers (42 male and 28 female, mean age 64.8±11.7 years) underwent cranial MRI and CT, and their HRV parameters,including SDNN(the standard deviations of R-R interval over 24-hour Holter recordings),SDANN (the standard deviations of the normal mean R-R interval obtained from successive 5-minute periods over 24-hour Holter recordings),SDNN Index (the normal mean of the standard deviations R-R interval obtained from successive 5-minute periods over 24-hour Holter),RMSSD (the root-mean square of the difference of successive R-R intervals),PNN50 (the number of instances per hour in which 2 consecutive R-R intervals differ by more than 50 ms over 24-hours) and HRVTI(HRV triangular index), were analyzed. Patients with ischemic stroke were assigned into 2 groups:hemisphere infarction group,consisting 73 patients,were further divided into right and left hemisphere group; brainstem infarction group, consisting 35 patients, were further divided into the medullary oblongata,pontine and midbrain groups. Results: In ischemic stroke group, hemisphere infarction group and brainstem infarction group, HRV parameters were much reduced compared with those in the control subjects (P<0.05). It was also found that HRV was lower in patients with right hemisphere lesions than with left hemisphere lesions. HRV decreased in patients with medullary oblongata infarction group; SDNN, RMSSD, and PNN 50 were reduced significantly in the pontine and midbrain. SDANN and SDNN Index were significantly lower in the pontine and midbrain infarction groups(P<0.05). Conclusion: The localization of ischemic stroke may have different effects on autonomic function. Patients with right hemisphere infarction, especially the medullary oblongata infarction may require mor

关 键 词：脑梗死 心率变异性 自主神经功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]