室间隔缺损封堵术对患者心率变异性的影响及意义  

The Effect and Significance of Transcatheter Closure on Heart Rate Variability in Patients With Ventricular Septal Defect

作　　者：宋治远[1] 张志辉[1] 李永华[1] 仝识非[1] 刘建平[1] 冉擘力[1] 庄国强[1] 

机构地区：[1]中国人民解放军第三军医大学第一附属医院心内科,重庆市400038

出　　处：《中国循环杂志》2007年第4期292-295,共4页Chinese Circulation Journal

摘　　要：目的：探讨室间隔缺损封堵术对患者心率变异性的影响及意义。方法：选择成功接受介入治疗的室间隔缺损患者165例为研究对象，分别于术前1天及术后第4天记录24小时动态心电图，由电脑自动分析并经心电专业人员校正，得出心率变异性的各项时域指标；另按心脏超声测得的肺循环血流量／体循环血流量（Qp／Qs）值将165例患者分为Qp／Qs〈1．5组与Qp／Qs≥1．5组并进行对比分析。另选健康体检者30例为正常对照组。结果：室间隔缺损封堵术前、术后心率变异性变化：与正常对照组比较，术前1天、术后第4天的RR间期、SDNN及SDANN均显著降低，有显著性差异（P〈0．05-0．01），而术前1天的rMSSD则显著增加，有显著性差异（P〈0．05）。与术前1天比较，术后第4天RR间期、SDNN及SDANN均明显增加，有显著性差异（P〈0．05-0．01）。室间隔缺损患者QP／QS对心率变异性的影响：按Qp／Qs分组后分析发现：与正常对照组比较，术前1天Qp／Qs〈1．5组、Qp／Qs≥1．5组患者的RR问期、SDNN及SDANN均降低，有显著性差异（P〈0．05-0．01），而rMSSD则增加，有显著性差异（P〈0．05-0．01）。与正常对照组比较，术后第4天Qp／Qs〈1．5组患者的SDNN及SDANN降低，而rMSSD、PNN50则增加，有显著性差异（P〈0．05～0．01）；Qp／Qs≥1．5组患者的RR间期、SDNN及SDANN也降低，均有显著性差异（P〈0．05-0．01）。术后第4天与术前1天比较，Qp／Qs〈1．5组患者SDNN及SDANN均增加，有显著性差异（P〈0．05）；Qp／Qs≥1．5组RR间期、SDNN及SDANN均增加，有显著性差异（P〈0．05-0．01），而rMSSD则降低，亦有显著性差异（P〈0．05）。结论：本组研究先心病患者术前及术后早期心率变异性均有不同程度降低，且心率变异性降低的程度与患者的预后密切相关。Objective ：To investigate the changes and significances of heart rate variability（HRV） before and after transcatheter closure of ventricular septal defect （VSD）. Methods ：165 patients receiving successful transcatheter closure were analyzed. The 12 leads ECG and 24-hourrecord of Holter were taken at 1 day before and 4 days after transcatheter closure. The results were automatically analyzed by computer and then corrected by professional electrocardiogram technician. The parameters of time domain of HRV and the ratio of pulmonary flow to systemic blood flow （ Qp/Qs, group I Qp/Qs 〈 1.5; group II Qp/Qs 〉 1.5 ） were analyzed. Results：Compared with the control group, R-R interval,standard deviation of all NN intervals （SDNN） and standard deviation of the averages of NN intervals in all 5 min segments of the entire recording （SDANN） were significantly decreased （P 〈 0. 01 ）, the square root of the mean of the sum of the squares of differences between adjacent NN intervals （rMSSD） was significantly increased （P〈0. 05）. R-R interval,SDNN and SDANN were increased after transcatheter closure and were close to those of the control group. Compared with control group,the R-R interval ,SDNN and SDANN in group II were much shorter. After transcatheter clo- sure, they became much longer than those of the group I, but there was no significant difference between two groups. Conclusion：The transcatheter closure of VSD has a minimal injury and rapid recovery. The progress and extent of HRV recovery are predictors the prognosis.

关 键 词：室间隔缺损 封堵器 介入治疗 心率变异性 

分 类 号：R541[医药卫生—心血管疾病]