不同时间段运动对冠心病患者心率变异的影响  

The influence of exercise at different times of day on heart rate variability in patients with coronary artery disease

作　　者：蒯正平[1] 连晓清[1] 赵姗[1] 高伟[2] 赵焕[3] 王连生[1] 杨志健[1] 

机构地区：[1]南京医科大学第一附属医院心脏科,南京210029 [2]南京医科大学第二附属医院老年科 [3]南京医科大学附属江宁医院

出　　处：《中国康复医学杂志》2015年第9期902-906,共5页Chinese Journal of Rehabilitation Medicine

基　　金：江苏省高校"青蓝工程"(苏教师[2013]39);江苏省自然科学基金面上项目(BK2012880)

摘　　要：目的:探讨不同时间段运动对冠心病患者心率变异的影响。方法:将105例符合入组标准的冠心病患者随机分为3组,对照组,早上和晚上运动组,每组各35例。对运动组患者分别进行早上和晚上运动干预,劝其以4—6.8km/h的速度快走,持续30—60min,每周至少运动5天。干预前及干预12周后分别行心率变异测定。结果:①与干预前相比,3组窦性心搏NN间期的标准差(SDNN)和全程记录中每5min NN间期平均值的标准差(SDANN)均显著增加,而运动组相邻NN间期差值的均方根(rMSSD)、24小时相邻NN间期差值>50ms的百分数(PNN50)和高频(HF)均显著增加(P<0.05);②干预后3组比较,晚上运动组rMSSD、PNN50和HF均显著高于其他两组(P<0.001);③在校正过基线的混杂因素后,rMSSD、PNN50、HF和低频(LF)/HF比值的变化程度有显著差异(P<0.001),其中晚上运动组rMSSD、PNN50、HF的改善程度显著优于其他两组(P<0.05)。结论:在琥珀酸美托洛尔(倍他乐克)治疗的基础上辅以中等强度的运动将进一步有效地改善冠心病患者的副交感神经活性,晚上运动的效果可能优于早上。Objective： To examine the influence of exercise at different times of day on heart rate variability（HRV） in patients with coronary artery disease.Method： A total of 105 patients were randomly assigned to a control group, morning or evening exercise group, with 35 cases in each group. Both the exercise groups were asked to walk at a speed of 4-6.8 km/h for 30min/d or more on at least 5d/week either on the morning or evening. HRV was measured before and af- ter the 12 weeks exercise intervention. Result： （1） Compared with baseline, all groups had a significant increase in standard deflation of NN interval （SDNN） and standard deviation of average NN interval（SDANN）, while the exercise groups had an increase in root mean square of successive difference（rMSSD）, PNN50 and high frequency（HF）（P 〈 0.05）. （2） Three months later, rMSSD, PNN50 and HF were significantly higher in the evening exercise group than the other groups （P〈0.001）. （3） After adjusted for baseline variables, significanees were shown in the changes of rMSSD, PNN50, HF and low frequency（LF）/HF ratio （P〈0.001）. The evening exercise group had a larger improvement in rMSSD, PNN50 and HF than that in the other two groups （P 〈 0.05）. Conclusion： Based on beta-blocker use, middle intensity exercise could successfully result in improvements in parasympathetic nerve activity. Evening exercise might gain more beneficial effects than morning exercise.

关 键 词：时间段 运动 冠心病 心率变异 

分 类 号：R541.4[医药卫生—心血管疾病] R493[医药卫生—内科学]