窒息新生儿心率变异性的临床研究  

Analysis of heart rate variability in neonatal asphyxia

作　　者：李敏[1] 谢利剑[2] 刘万红[1] 顾月萍 王健怡[2] 陈一欢[1] 裘刚[1] 

机构地区：[1]上海市儿童医院上海交通大学附属儿童医院新生儿科,200040 [2]上海市儿童医院上海交通大学附属儿童医院心内科,200040 [3]上海市长宁区妇幼保健院新生儿科,200051

出　　处：《中国小儿急救医学》2012年第1期59-61,共3页Chinese Pediatric Emergency Medicine

摘　　要：目的探讨窒息新生儿心率变异性（heart rate variability，HRV）与心肌损害的相关性。方法对53例窒息新生儿与40例健康新生儿进行24h全程动态心电图记录，对24h窦性心律进行HRV时域分析，时域分析指标包括：正常窦性R—R问期的标准差（SDNN）；全程记录中每5分钟R—R间期平均值的标准差（SDANN）；全程记录中每5分钟R—R间期标准差的平均值（SDNNindex）；相邻R．R间期差值的均方根值（rMSSD）；正常R—R间期标准差〉50ms的百分比（PNN50）。结果（1）窒息新生儿与正常对照新生儿24h最快心率、最慢心率、平均心率比较，差异均有统计学意义（P〈0．05）；轻、重度窒息新生儿间以上指标比较差异也有统计学意义（P〈0．05）；重度窒息3种心率指标明显降低。（2）HRV时域分析中，轻、重度窒息新生儿SDNN、SDANN与正常对照新生儿比较差异有统计学意义（P〈0．05），轻、重度窒息SDNN、SDANN、SDNNindex、rMSSD及PNN50 5项指标组间比较差异无统计学意义（P〉0．05）。SDNNindex、rMSSD及PNN503组间未见明显差异。结论新生儿窒息心肌损害会导致心脏自主神经功能受损并影响心率的变化，受损程度与窒息缺氧严重程度有关。Objective To explore the relation of heart rate variability （HRV） in neonatal asphyxia with myocardial injury. Methods Continuous electrocardiographic monitoring by 24-hour Holter recordings was performed in 53 neonates with asphyxia and 40 healthy newborn. The difference of HRV with sinus rhythm was analyzed. Time-domain indexs included standard deviation of R-R intervals （SDNN） ; standard deviation of all mean 5-minute R-R intervals （SDANN） ; standard deviation of all R-R intervals for all 5-minute segments of 24 hours （SDNNindex ） ;root mean squared successive difference （rMSSD） ;percent of NN50 in the total number R-R intervals （ PNN50 ）. Results （ 1 ） Maximum heart rate, minimum heart rate and average heart rate of 24-hour Holter in healthy newborn were faster than those in newborn with neonatal asphyxia （P 〈 0. 05 ）. And the heart rate was faster in newborn with mild neonatal asphyxia than that in newborn with serious neonatal asphyxia （ P 〈 0. 05 ）. （2） SDNN, SDANN of HRV index analysis showed significantly difference between healthy newborn and asphyxia newhorn （ P 〈 0. 05 ）. There were no difference of SDNN, SDANN, SDNNindex, rMSSD and PNN50 between mild and serious neonatal asphyxia （ P 〉 0.05 ）. No significant differences of SDNNindex ,rMSSD and PNN50 were found among three groups. Conclusion Myocardial injury caused by neonatal asphyxia can lead to damage of cardiac autonomic nevous and affect heart rate changes. The degree of myocardial injury is related to the degree of neonatal asphyxia.

关 键 词：新生儿窒息 心率变异性 自主神经 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]