慢性阻塞性肺病伴呼吸衰竭患者心脏自主神经系统功能的变化及其临床意义  

Analysis of Heart Autonomic Nervous System in Patients with Respiratory Failure Caused by Chronic Obstructive Pulmonary Disease

作　　者：倪崇俊[1] 高美雯[2] 金建铃[2] 黄建安[1] 马家用[1] 

机构地区：[1]苏州大学附属第一医院呼吸科,江苏苏州215006 [2]苏州大学附属第一医院心内科,江苏苏州215006

出　　处：《苏州大学学报（医学版）》2007年第5期757-758,768,共3页Suzhou University Journal of Medical Science

摘　　要：目的探讨慢性阻塞性肺病(COPD)合并呼吸衰竭时心脏自主神经系统功能的变化及其临床意义。方法对37例COPD患者及48例正常对照组进行24 h动态心电图监测,分析心率变异性(HRV)时域指标及24 h室上性和室性心律失常事件发生数,COPD组给予肺功能和血气分析检测。结果根据血气分析结果,COPD分为伴呼吸衰竭组(24例)和不伴呼吸衰竭组(13例),两组HRV指标SDNN、SDNNI、PNN50、Tria、SDANN、RMSSD均较对照组明显降低(P<0.05),且伴呼吸衰竭组SDNN、PNN50、Tria、RMSSD下降更明显(P<0.05);两组夜间心率、室性及室上性异位心律发作次数较对照组增高(P<0.05),伴呼吸衰竭组较不伴呼吸衰竭组室性及室上性异位心律发作次数更高(P<0.05)。结论COPD伴呼吸衰竭患者存在着交感神经和副交感神经损伤,但副交感神经损害更严重,且较不伴呼吸衰竭患者更多出现室性与室上性心律失常发生事件。Objective To evaluate heart autonomic nervous system （ANS） in patients with respiratory failure caused by chronic obstructive pulmonary disease （COPD） by 24-hour heart rate variability （HRV） monitoring. Methods Thirty-seven COPD patients and 48 controls were included, 24 hour Holter ECG recordings were analyzed for cardiac arrhythmias and circadian changes in HRV. The lung function test and blood gas analysis were performed in the COPD group. Results The COPD group was divided to the respiratory failure group （RF group, n=24） and non RF group（n=13） with blood gas analysis. The time domain indices of HRV （SDNN,SDNNI,PNN50,Tria,SDANN and RMSSD） in RF and non RF groups were reduced compared with those in the control subjects （P〈0.05）, the indices （SDNN,PNN50,Tria and RMSSD） were significantly reduced in the RF group than those in the non RF group （P〈0.05）. The supraventricular and ventricular arrhythmias complexes were significantly higher in the RF group than those in the non RF group compared with those in the control group. Conclusion COPD patients with RF have markedly damage of ANS and high cardiac arrhythmias complexes cornpared with those in the patients without RF failure.

关 键 词：慢性阻塞性肺病 心率变异性 呼吸衰竭 

分 类 号：R563.804[医药卫生—呼吸系统]