孤立性心房颤动患者心率变异与 P 波离散度的相关性研究  

Relationship Between the Heart Rate Variability and P-Wave Dispersion in Lone Atrial Fibrillation Patients

作　　者：程怡[1] 岳梅[1] 孟洋[1] 

机构地区：[1]齐齐哈尔医学院第一附属医院功能科,黑龙江省齐齐哈尔市161041

出　　处：《中国循环杂志》2008年第4期249-252,共4页Chinese Circulation Journal

摘　　要：目的:探讨孤立性心房颤动患者心率变异性(HRV)与 P 波离散度(P_d)的关系。方法:在动态心电图上分析30例孤立性心房颤动患者(房颤组)的心率变异性指标,包括孤立性心房颤动发作前、后5分钟的时域、频域指标:RR 间期的标准差、低频段功率、高频段功率以及低频段功率/高频段功率和24小时时域指标:全部 RR 间期的标准差、每5分钟平均 RR 间期的标准差、相邻 RR 间期差值的均方根和相邻 RR 间期差值大于50 ms 的心搏数占总心搏数的百分比,并计算 P 波最大宽度与 P 波离散度,再与30例正常对照组进行比较。结果:①对孤立性心房颤动患者发作前、后5分钟的时域、频域指标进行比较,可见孤立性心房颤动患者发作前5分钟 RR 间期的标准差、高频段功率较发作后5分钟增高(P<0.05),而低频段功率/高频段功率降低(P<0.05),差异有统计学意义,低频段功率无明显变化(P>0.05)。②24小时时域分析显示房颤绀的全部 RR 间期的标准差、每5分钟平均 RR 间期的标准差、相邻 RR 间期差值的均方根和相邻 RR 间期差值大于50 ms 的心搏数占总心搏数的百分比高于正常对照组(P<0.01),差异有统计学意义。③房颤组的 P 波最大宽度、P 波离散度高于正常对照组(P<0.01),差异有统计学意义。④房颤组的全部 RR 间期标准差、每5分钟平均 RR 间期的标准差、相邻 RR 间期差值的均方根和相邻 RR 间期差值大于50 ms 的心搏数占总心搏数的百分比与 P 波最大宽度、P 波离散度旱正相关(P<0.01),差异有统计学意义。结论:孤立性心房颤动患者迷走神经张力增高,特别在发作前迷走神经张力有明显增强,并且其 P 波最大宽度、P 波离散度显著增高,两者之间有一定的相关性,可能是孤立性心房颤动的发病机制之一。Objectives： To study the relationship between heart rate variability（HRV） and P-wave dispersion （Pd） in patients with lone atrial fibrillation. Methods： Heart rate variability were analyzed in dynamic electrocardiogranl in 30 patients of lone atrial fibrillation（ fibrillation group）with 30 healthy individuals as notarial control（ control group）. Main heart indexes were included in time-domain ：5 minutes before and alter the fibrillation, and the frequency-domain ： standard deviation during time of RR （ SDNN ） , low frequency （LF）, high frequency（HF） and the ratio of LF/HF;24 hours time-domain： SDNN,root of mean square from standard deviavion in every 5 minuts （SDANN）, standard deviation in every 5 minutes during time of RR （RMSSD）, percentage of heart rate variability larger than 50 ms（PNNSO）. P-wave maximum breadth（ Pmax ） and P-wave dispersion（Pd ） were measured in both groups respectively. Results： （1）In fibrillation group, SDNN and HF increased 5 minutes before lone atrial fibrillation compared with 5minutes after the fibrillation （ P 〈 0. 05 ）, while LF/HF decreased 5 minutes after the outbreak （ P 〈 0. 05 ）, the differences had the statistic meaning. No obvious changes in LF（ P 〉 0. 05 ）. （2）Compared with control group, SDANN, RMSSD and PNN50 were higher in fibrillation group by 24 hours time-domain analysis（ P 〈 0. 01 ）. （3）Pmax and Pd in fibrillation group were larger than control group（ P 〈 0. 01 ）. （4）In fibrillation group, the results showed a positive correlation between SDNN, SDANN, RMSSD, PNN50 and Pmax, Pd （ P 〈 0. 01 ） , and all those differences had the statistic meaning. Conclusion： The vagal activation increased in the patients with lone atrial fibrillation. Before the outbreak, significant vagal activation and Pmax, Pd increase were observed and this correlation might be one of the pathogenesis of lone atrial fibrillation.

关 键 词：孤立性心房颤动 心率变异性 P波离散度 

分 类 号：R541.7[医药卫生—心血管疾病]