合并室性心律失常的心衰患者LVEF、BNP及HRV的变化及对近期预后的预测  

作　　者：喻学刚[1] 王军昌[1] 白秋生[1] 于娜[1] 麦永东[1] 张宜雅[1] 

机构地区：[1]广州中医药大学祈福医院心血管内科,510410

出　　处：《当代医学》2011年第20期27-28,39,共3页Contemporary Medicine

摘　　要：目的观察伴或不伴室性心律失常的心力衰竭患者心功能(LVEF)、B型利钠肽(BNP)及心率变异(HRV)的改变,探讨其与近期预后的关系。方法将132例心力衰竭患者按伴或不伴室性心律失常分为两组,通过体表12导联心电图和动态心电图分析,比较58例合并室性心律失常与74例无室性心律失常的心衰患者LVEF、BNP及HRV的改变,观察住院期间和出院6月时死亡率,研究其相互之间的关系。结果入院时伴和不伴室性心律失常患者LVEF无显著差别(33.66±7.48vs38.25±8.47,P>0.05)。两组BNP有显著差别(769.72±75.36vs1326.98±96.42,P<0.05)。无室性心律失常组HRV部分指标(SDNN、LF、HF)较优(P<0.05)。两组住院期间死亡率分别为6.35%和10.34%(P>0.05)。出院6月时的死亡率为12.16%和20.18%(P<0.05)。结论合并室性心律失常的心衰患者死亡率明显增加。BNP对两组的死亡率均有较好的预测作用,HRV与合并室性心律失常患者的死亡率相关,LVEF不能预测两组的死亡率。Objective To investigate the changes of heart rate variability（HRV）,B-type netriuretic peptide（BNP） and left ventricular ejective fraction（LVEF） as well as predictive value of admission and 6 month on ventricular arrythmias in patients with heart failure.Methods 132 patients with heart failure were randomly divided to two groups：group 1 with and group 2 without ventricular arrythmias.24 h ambulatory electrocardiogram was examed,HRV,BNP and LVEF were analysed during admission and 6 month after discharge.Results The rate of mortality in group 1 and group 2 was respectively 6.35% and 10.34%,P0.05,during in-hospital and 12.16%,20.18%（P0.05） in 6 month after discharge.BNP was significantly increased and HRV parameters was obviously amelioated at admission（P0.05） and 6 month（P0.01） after discharge in group 1 compared with in group 2.But the difference was not significant in LVEF（P0.05）.Conclusion The rate of mortality is obviously higher in group 2 than in group 1.BNP changes can better predict the rate of mortality in group 1 and group 2.The HRV parameters can predict rate of mortality in patient of heart failure with ventricular arrhthmia.LVEF is not coinciding with rate of mortality.

关 键 词：心力衰竭 室性心律失常 心率变异性 B型利钠肽 左室射血分数 

分 类 号：R541.6[医药卫生—心血管疾病] R541.7[医药卫生—内科学]