手术前后先天性心脏病患儿心率变异性的非线性动力学分析  

The analysis of nonlinear dynamics of the heart rate variability pre and post operation in congenital heart diseases

作　　者：韩玲[1] 刘亦未[1] 罗毅[1] 程沛[1] 金梅[1] 吴邦骏[1] 李玲[1] 张辉[1] 王磊[1] 刘秉正 刘虎[1] 李磊[1] 

机构地区：[1]首都医科大学附属北京安贞医院小儿心脏科,100029

出　　处：《中华儿科杂志》2000年第3期166-170,共5页Chinese Journal of Pediatrics

摘　　要：目的　探讨心率变异 (HRV)性的非线性动力学分析在预测先天性心脏病术后风险中的应用。方法　应用非线性动力学方法和传统的频域方法分析两组先天性心脏病———室间隔缺损(VSD)和法洛四联症 (TOF)患儿术前术后心率变异的变化。结果　 (1)术前两组患儿HRV频域及非线性动力学指标均无明显差异 (P >0 .0 5 ) ;(2 )两组患儿术后第 1天HRV频域和非线性动力学指标较术前有明显改变 (P <0 .0 5 ,P <0 .0 1) ;(3)术后两组HRV频域指标均无明显差异 ,而非线性动力学部分指标差异有非常显著意义 (P <0 .0 1)。 (4)术前两组先天性心脏病患儿心率变异的庞卡莱图为慧星状。VSD患儿术后表现为鱼雷状 ,TOF者表现为复杂形或短棒状。VSD术后 10d恢复为慧星状 ,而TOF患儿仍为复杂形。结论　此研究提示心率变异非线性动力学分析方法较线性分析敏感 ,可能为心脏突发事件提供更多的信息。Objective To investigate the clinical significance of the nonlinear dynamics method in analyzing the heart rate variability (HRV) of congenital heart diseases (CHD). Methods By using the nonlinear dynamics method and the power spectrum method, the authors analyzed the HRV signals pre and post operation in 2 groups of CHD patients, ventricular septal defect (VSD) and tetralogy of Fallot (TOF). Results (1) There were no significant differences of all indices between two groups pre operation ( P >0.05). (2) The indices of the power spectrum and nonlinear dynamics pre operation were significantly different from those post operation ( P < 0.05, P <0.01). (3) After operations, the indices of nonlinear dynamics in TOF group were significant lower than those in VSD group ( P < 0.01), but power spectrum indices showed no difference. (4) Before operations, the Poincare plot of HRV in two groups of patients displayed the pattern of comet. After operations, the Poincare plot of VSD patients showed the torpedo pattern at first, and then gradually changed to the cometic pattern at the 10th day after the operations. The Poincare plot of TOF patients showed the complex patterns after operations, and remained in this pattern at the 10th day after operations. Conclusion Nonlinear dynamics method seems to be a more sensitive method than the traditional method, and might provide more information about unexpected incidents of heart diseases.

关 键 词：先天性心脏病 儿童 心率变异性 非线性动力学 

分 类 号：R726.5[医药卫生—儿科]