心率震荡在慢性充血性心力衰竭患者中的变化规律及预测价值  

Change and prognostic value of HRT in CHF patients

作　　者：郭佳[1] 王瑞英[1] 王红宇[1] 汪红霞[1] 

机构地区：[1]山西医科大学,山西太原030001

出　　处：《中国心血管杂志》2006年第6期425-428,432,共5页Chinese Journal of Cardiovascular Medicine

基　　金：山西省卫生厅科技攻关项目(编号:200504)

摘　　要：目的研究心率震荡（HRT）在慢性充血性心力衰竭（CHF）患者中的变化规律及对其预后的预测价值，比较正常人与CHF患者以及不同心功能级别、病因、危险度CHF患者的HRT变化。方法72例CHF患者和50例正常对照均接受动态心电图（Holter）、超声心动图等检查，记录临床资料，分别计算HRT的两个参数震荡初始（TO）和震荡斜率（TS），并进行6～30个月的随访。结果CHF患者TO明显高于对照组，TS明显低于对照组（P〈0．05）；重度CHF患者TS明显低于轻度CHF患者（P〈0．05）；各种病因所致CHF之间HRT变化无明显差异；TS在高危组和低危组差异显著（P〈0．05），前者低于后者；TS和心率变异性（HRV）、左心室射血分数（LVEF）呈正相关；多变量分析结果显示LVEF、TS、以及TO、TS值联合作为一个指标对终点事件的预测有显著性意义（P〈0．05），TO和TS联合成为预测价值最高的指标（相对危险度为4．157），远远高于LVEF（相对危险度为0．955）及其他指标。结论CHF患者HRT现象明显减弱，HRT不仅可以作为判断CHF严重程度的指标，而且可以作为预测CHF患者预后的敏感指标之一。Objective To invest the change regularity and prognostic value of heart rate turbulence （HRT） in chronic heart failure（CHF） patients. Comparing the difference of HRT between the CHF group, control group and subgroups. Me thods 72 CHF patients as CHF group and 50 health persons as control. Then the basle information, were collected HRT, heart rate variability（HRV） from Holter and left ventricular eject fraction（LVEF） from UCG. Results HRT were significant absent in CHF patients; TS in severe patients were significant lower than those in mild patients （P 〈 0.05 ） ; There was no significant difference between subgroups of different etiopathogenisis（ P 〉 0.05 ） ; TS in the high-risk patients were lower than those in the low-risk patients. There was positive correlation between TS and LVEF, and HRV in CHF group （P 〈 0.05）. In the multivariate analysis, LVEF,TS and combination of TO and TS were sensitive predictors. Conclusion HRT io significant weaked in CHF patients, it maybe indicate the CHF patient＇ s severity degree and is one of the sensitive predictor of high-risk CHF patients.

关 键 词：心率震荡 慢性充血性心力衰竭 左心室射血分数 心率变异性 

分 类 号：R541.6[医药卫生—心血管疾病]