老年慢性阻塞性肺病患者窦性心率震荡及心率变异性的研究  

Clinical significance of sinus heart rate turbulence and heart rate variability in patients with chronicobstructive pulmonary disease

作　　者：郭海鹏[1] 唐其柱[1] 刘畅[2] 刘慧红[3] 邓伟[1] 周恒[1] 沈涤非[1] 

机构地区：[1]武汉大学人民医院心内科,武汉430060 [2]武汉大学中南医院重症监护科 [3]山东济宁医学院附属医院呼吸科

出　　处：《中华老年医学杂志》2011年第3期177-180,共4页Chinese Journal of Geriatrics

基　　金：国家博士学科点专项科研基金（200700486103）;武汉市科技攻关项目（200960323127）

摘　　要：目的探讨慢性阻塞性肺病（COPD）患者窦性心率震荡（HRT）及心率变异性（HRV）变化及临床意义。方法临床诊断为COPD老年患者59例，选择同期健康老年人30例为对照组。24h动态心电图检测各组HRT参数：震荡初始（T0）和震荡斜率（TS）及HRV各项指标，肺功能检测，同时超声心动图测量左心室射血分数（LVEF）、右心房内径（RAD）、右心室内径（RVD）、右心室壁厚度（RVwT）等指标；组间比较且对HRT与HRV指标进行相关性分析。结果与对照组比较，COPD患者TO值显著增高[（-0．2±1．1）％与（-3．8±2．8）％，t=6．830，P％0．01]，TS值显著下降[（7．0±3．6）与（11．7±6．1）ms／RR，t=3．866，P〈0．01]；HRV指标正常R—R间期的标准差（SDNN）、正常R—R间期的标准差的平均值（SDNNI）、SDNNI的标准差（SDANN）、相邻R—R间期之差的均方根值（rMSSD）和正常R-R间期标准差≥50ms的百分数（PNN50）增加，且随肺动脉压力的增高而恶化。TO与SDANN，rMSDD呈负相关（r=-0．369，P〈0．05；r=-0．472，P〈0．01），TS和SDNN，SDANN，PNN50呈正相关（P〈0．05），与rMSDD无相关性（P〉0．05）。结论COPD患者HRT现象减弱，HRT和HRV变化随患者肺动脉压力的增加而恶化，联合检测对评价cOPD患者自主神经功能状态及预后有较高临床价值。Objective To explore the clinical significance of sinus heart rate turbulence （HRT） and heart rate variability （HRV） in patients with chronic obstructive pulmonary disease （COPD）. Methods The 59 moderate to severe COPD patients and 30 healthy subjects were enrolled in this study. The 24-hour holter monitor was used to screen the HRT onset （TO）, turbulence slope （TS） and HRV. Pulmonary function tests and echocardiographic examination were performed for measuring left ventricular ejection fraction （LVEF）, right atrial dimension （RAD）, right ventricular dimension （RVD） , right ventricular wail thickness （RVWT）. Then all the parameters were compared between NC group and COPD group, and the relationship between HRT and HRV was investigated. Results Compared with control group, TO was significantly increased [（-0.2± 1.1）% vs. （-3.8±2.8）%, t=6.830,P〈0.01] and TS was decreased [（7.0±3.6） ms/RRvs. （11.7±6.1） ms/RR, t =3. 866,P〈0. 012 in COPD group. In time domain HRV parameters, normal RR intervallerinin standart deviation （SDNN）, standard deviation of normal-to-normal beats index （SDNNi）, standard deviation of the averages of normal sinus to normal sinus （SDANN）, mean squared differences of the successive RR intervals （rMSDD）, fraction of consecutive normal sinus intervals that differ by more than 50 ms （PNNS0） were significantly lower in COPD group than in control group （P%0.05）. TO was negatively correlated with SDANN and rMSDD （r=--0. 369, P〈0.05; r=-0. 472, P〈0.01）. TS was positively correlated with SDNN, SDANN and PNN50 （all P%0.05）, but had no correlation with rMSDD （P〉0.05）. Conclusions HRT and HRV are dramatically blunted in COPD patients.Combination of HRV and prognosis, and HRT may be simple and elegant ways for evaluating cardiac autonomic functions.

关 键 词：肺疾病 慢性阻塞性 心律失常 心率 

分 类 号：R563.9[医药卫生—呼吸系统]