冠心病心力衰竭患者脉压与心率变异性的关系及其预后意义  

Relationship between pulse pressure and heart rate variability and its prognostic value in patients with heart failure due to coronary heart disease

作　　者：钟杭美[1] 罗昭林[1] 刘春燕[1] 刘莉[1] 耿召华[1] 祝善俊[1] 

机构地区：[1]第三军医大学新桥医院全军心血管病研究所,重庆400037

出　　处：《岭南心血管病杂志》2011年第1期36-40,共5页South China Journal of Cardiovascular Diseases

基　　金：二00七年度第三军医大学临床科研基金课题(项目编号:48)

摘　　要：目的通过对冠状动脉粥样硬化性心脏病(冠心病)心力衰竭(心衰)患者脉压与心率变异性(heart rate variability,HRV)的分析,探讨脉压及HRV对冠心病心衰患者自主神经功能的影响及其预后意义。方法选择冠心病心衰患者101例,同时采用动态血压监测与12导联动态心电图检查,以脉压≥60mmHg组(宽脉压组,n=38,1mmHg=0.133kPa)和脉压<60mmHg组(正常脉压组,n=63)分为两组,对其进行分析并随访观察。结果宽脉压组年龄明显大于正常脉压组,差异有统计学意义(P<0.01);24h收缩压、白昼及夜间收缩压,24h脉压、白昼及夜间脉压高于正常脉压组,差异均有统计学意义(P<0.001);白昼心率低于正常脉压组,差异有统计学意义(P<0.05)。宽脉压组SDNN、SDANN显著低于正常脉压组,差异有统计学意义(P<0.001)。宽脉压组在随访期间总的心血管事件发生率明显高于正常脉压组,差异有统计学意义[32.4%(11/34)vs.13.3%(8/60),P<0.05];其中,宽脉压组心绞痛加重再次入院的发生率高于正常脉压组,差异有统计学意义[17.6%(6/34)vs.3.3%(2/60),P<0.05]。结论冠心病心衰患者脉压增大对自主神经功能损害有影响,且以交感神经兴奋性增加为主,提示脉压增大及HRV降低是冠心病心衰患者预后不良的重要指标。Objectives To determine the effect of pulse pressure（PP）on autonomic nervous function and its prognostic value in patients with heart failure due to coronary heart disease, based on the analysis of their pulse pressure and heart rate variability （HRV）. Methods One-hundred and one inclusive patients with heart failure due to coronary heart disease were monitored by ambulatory blood pressure monitoring （ABPM） and 12-lead ambulatory electrocardiogram （12- head AECG）, and then were divided into two groups： wide PP group （PP≥60 mm Hg,n= 38,1 mm Hg=0.133 kPa） and normal PP group （PP〈60 mm Hg,n=63）. A study was made by follow-up. Results Patients were older,and mean values of 24-hour systolic blood pressure （SBP）, daylight SBP and night SBP were increased significantly, while mean value of daylight heart rate were decreased strikingly in the wide PP group when compared with the normal PP group （P〈0.05）. Patients in wide PP group had lower values of SDNN and SDANN than those in normal PP group （P〈 0.001 ）. The incidence of adverse cardiovascular events in wide PP group was statistically higher than in normal PP group [32.4% （11/34）vs. 13.3% （8/60）,P〈0.05], and the prevalence of re-hospitalization due to angina deterioration in wide PP group was statistically higher than in normal PP group [17.6% （6/34）vs. 3.3% （2/60）,P〈 0.05 ]. Conclusions The increase of PP has affect to the injury of autonomic nervous function in patients with heart failure due to coronary heart disease, and mainly the excitation of sympathetic nerve increases ; this indicates that increase of PP and decrease of heart rate variability has a good prognostic value in patients with heart failure due to eoronary heart disease.

关 键 词：冠状动脉疾病 心力衰竭 脉压 心率变异性 预后 

分 类 号：R541.4[医药卫生—心血管疾病]