老年慢性心力衰竭患者心率震荡的临床研究  

Clinical significance of heart rate turbulence in elderly patients with chronic heart failure

作　　者：任军梅[1] 王瑞英[1] 刘毅坚[1] 王希巧[1] 郭完计[1] 郭佳[1] 

机构地区：[1]山西省晋城煤业集团总医院心内科,晋城市048006

出　　处：《中华老年医学杂志》2007年第10期748-751,共4页Chinese Journal of Geriatrics

基　　金：山西省卫生厅科技攻关项目（200504）

摘　　要：目的研究心率震荡（HRT）对老年慢性心力衰竭（心衰）患者的预后判断价值。方法110例慢性心衰患者和62例健康对照者均记录临床资料,测量左心室射血分数（LVEF）、心率变异性的时域指标正常心动周期的标准差（SDNN）、平均心率及震荡初始（TO）和震荡斜率（TS）。根据TO、TS的组成不同及LVEF分为HRT0、HRT1和HRT2组进行随访.并分析各危险变量对患者死亡的预测价值。结果慢性心衰患者HRT现象明显减弱[TO：（0.37±1.83）%,TS：（8.58±4.72）mm/RR,P〈0.05];重度慢性心衰患者TS：（7.09±4.51）mm/RR,明显低于轻度慢性心衰患者的TS：（11.02±4.37）mm/RR（P〈0.05）。随访（34.0±11.5）个月,26例死亡,84例存活,死亡组TS：（4.64±2.61）mm/RR,明显低于存活组的（9.30±4.26）mm/RR（P〈0.05）;TO与心率变异性（HRV）呈负相关（r=-0.275,P〈0.05）,TS与HRV、LVEF呈正相关（r分别为0.391、0.406,P〈0.05）,与平均心率呈负相关（r=-0.49,P〈0.05）,TO与TS无明显相关（r=-0.185,P〉0.05）。单变量分析显示,HRT2具有最强的预测意义;多变量分析显示,LVEF〈40%、HRT2为对终点事件有预测价值的变量（P〈0.05）。生存曲线表明,HRT0、HRT1、HRT2组生存状况有差异,HRT2组预后最差。结论HRT不仅可以作为判断慢性心衰病情严重程度的指标,而且是预测慢性心衰患者预后的指标。Objective To investigate the prognostic value of heart rate turbulence（ HRT） for elderly chronic heart failure（CHF） patients. Methods One hundred and ten CHF patients and 62 healthy person were enrolled in the study. CHF patients were classified into mild group and severe group according to LVEF. Left ventricular ejection fraction was measured by ultrasonic cardiography. Heart rate variability （HRV）, mean heart rate, turbulence onset （TO） and turbulence slope （TS） were calculated from Holter records. Patients were classified into the following HRT categories： HRT0, HRT1 , HRT2, then were followed up. According to the results, patients were divided into the survival group and the death group. The predictive values of the HRT variables for high-risk patients with CHF were assessed between the two groups. Results The HRT variables in CHF group （TO： （0.37 ± 1.83） M ; TS： （ 8.58 ± 4.72 ） mm/RR, P 〈 0.05） were lower than those of the control group. TS of the severe CHF group[（7. 09±4.51） mm/RR] were lower than that of the mild group[（11. 02±4.37） mm/RR,P〈0. 05）]. During a follow-up of （34.0±11.5） months, 26 patients died, 84 survived. TS of the death group[（4. 64±2.61） mm/RR） were significant lower than that of the survival group[（9. 30±4.26） mm/RR, P〈0.05）. TO was significantly correlated with HRV （r=-0. 275, P〈0. 05）. TS was significantly correlated with HRV, LVEF, mean heart rate in CHF patients（r=0. 391,0. 406, P〈0.05）. There was no significant correlation between TO and TS （r= -0. 185,P〉0.05）. Univariate analysis found that HRT2 was the strongest predictor （P〈0.01）. Multivariate analysis found that only LVEF≤40 and HRT2 had prognostic value to the primary end point; survival curve suggested that there was significant difference in survival status among HRT0 group, HRT1 group and HRT2 group （all P 〈 0. 05）. HRT2 group had the worst prognosis. Conclusions It suggests that HRT is not only an index to decide th

关 键 词：心率 心力衰竭 充血性 病死率 

分 类 号：R686[医药卫生—骨科学]