采用心率变异性分析抗胆碱能药物治疗前后哮喘患者自主神经的变化  

Changes of autonomic nervous system in asthma patients before and after anticholinergic drugs treatment using heart rate variability parameters

作　　者：李晓[1,2] 沈瑛[3] 刘翱[1,2] 

机构地区：[1]昆明医科大学昆明总医院临床学院 [2]成都军区昆明总医院呼吸内科,昆明650032 [3]云南省建水县人民医院,云南654300

出　　处：《中华肺部疾病杂志（电子版）》2013年第6期40-45,共6页Chinese Journal of Lung Diseases(Electronic Edition)

摘　　要：目的探讨使用长效抗胆碱能药物噻托溴铵治疗成人哮喘6周前后的自主神经功能改变及临床效果。方法 45例非急性发作的中度哮喘患者随机分为A组15例:噻托溴铵粉吸入剂+丙氟酸氟替卡松气雾剂组;B组15例:吸入沙美特罗替卡松干粉剂组;C组15例:噻托溴铵粉吸入剂+沙美特罗替卡松干粉剂。观察三组患者治疗前后心率变异性、肺功能指标及症状控制情况。结果①治疗6周后,A组的HF、PNN50降低,与用药前对比差异有统计学意义(P<0.05),LF、SDANN增高,差异无统计学意义(P>0.05);B组的HF、PNN50降低,LF、SDANN增高,与用药前对比差异均无统计学意义(P>0.05);C组的HF、PNN50降低,LF、SDANN增高,与用药前对比差异均有统计学意义(P<0.05);②三组的日间、夜间症状评分较用药前有所降低,使用短效β2-受体激动剂的次数减少,肺功能中的FEV1、FEV1%较用药前改善,三组与治疗前对比差异均有统计学意义;③组间对比得出心率变异性的定量分析指标(HF、PNN50、LF、SDANN)A组与B组,B与C组有统计学意义(P<0.05),A组与C组差异无统计学意义(P>0.05);肺功能中的FEV1、FEV1%显示A组与B组无统计学意义(P>0.05),而A组与C组、B组与C组差异均有统计学意义(P<0.05);日间、夜间症状评分、使用短效β2-受体激动剂的次数显示A组与B组差异无统计学意义(P>0.05),A组与C组,B组与C组差异有统计学意义(P<0.05)。长效抗胆碱能药物噻托溴铵粉吸入剂联合糖皮质激素可以降低HF、PNN50,使迷走神经兴奋性降低,与长效β2-受体激动剂(LABA)联合糖皮质激素相比在改善肺功能中FEV1、FEV1%值,减少使用短效β2-受体激动剂的次数,降低哮喘症状评分方面,效果相当。结论以上三种药物联合使用在改善肺功能、降低心率变异性、降低哮喘症状评分及使用短效β2-受体激动剂次数等方面均表现出更明显的优势。Objective To observe the efficacy and the changes of autonomic nervous systemon using heart rate variability in the asthma patients before and after 6 weeks anticholinergic drugs treatment. Method 45 non-acute exacerbation moderate adult asthma patients were divided into three groups randomly. It was evaluated that the addition of tiotropium bromide to an inhaled glucocorticoid in the treatment group, A （n=15 ）, as compared with the addition of salmeterol group, B（ n = 15 ） and the combined inhalation group, C（ n = 15）. Serial measurements of heart rate variability, lung function and symptom control were performed. Result ①After 6 weeks of treatment, HF and PNN50 of group A were decreased. There was statistically significant difference between before and after the treatment, （ P 〈 0.05 ）. The LF and SDANN of group A was increased. There was no statistically significant difference between before and after the treatment （ P 〉 0.05 ）. HF and PNN50 of group B were decreased, LF and SDANN were increased. There was no statistically significant difference between before and after the treatment （P 〉 0.05 ）. I4F and pNN50 of group C were decreased, LF and SDANN were increased. There was statistically significant difference （ P 〈 0.05 ） ; ②The daytime and nighttime symptom scores, the times of using a short-acting beta 2-agonist of three groups were lowered after the treatment. The FEV1 , FEV1 % were improved after the treatment. There was statistically significant difference （P 〈 0. 05 ） ;③The quantitative indexes of heart rate variability were compared in groups. There was statistically significant difference between group A and group B, group B and group C, there was no statistically significant difference between group A and group C. The FEV1 and FEV1 % showed no statistically significant group A and group B, but there was statistically significant difference between group A and group C, group B and group C. The daytime and nighttime symptom scores, the times of using a s

关 键 词：心率变异性 支气管哮喘 抗胆碱能药物 自主神经 

分 类 号：R562[医药卫生—呼吸系统]