急性出血性脑血管病患者的心率减速力  

Clinical study of deceleration capacity of rate in patients with acute hemorrhagic cerebral vascular disease

作　　者：徐春芳[1] 黄芬[1] 杨晓云[1] 左萍[1] 王铁锚[1] 樊静静[1] 李丹[1] 吴杰[1] 

机构地区：[1]华中科技大学附属同济医院心血管内科,湖北武汉430030

出　　处：《中国心脏起搏与心电生理杂志》2015年第5期466-469,共4页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨急性出血性脑血管病患者心率减速力（DC）的变化及可能的应用价值。方法选取急性脑出血、原发性蛛网膜下腔出血（SAH）患者128例，其中SAH组48例，右基底节区出血组30例，左基底节区出血组28例，非基底节区出血组22例，于入院当日行24h动态心电图监测。选取体检正常者80例作对照。计算机自动计算各组DC值及心率变异（HRV）值。入选卒中患者按照DC≤2．5ms、DC2．6—4．5ms、DC〉4．5ms分组，统计各组24h平均心率、心律失常事件、ST-T改变、肌钙蛋白（cTnT）增高、左室射血分数（EF）以及临床转归等临床指标。统计不同卒中部位DC≤4．5ms及DC〉4．5ms的发生率。对人选患者随访6个月，计算病死率。结果与正常组比较，各卒中组DC及HRV值显著性降低（P〈0．01），不同卒中组间比较无显著性差异。与DC〉4．5ms组比较，DC≤2．5ms组的24h平均心率、心律失常事件、cTnT增高、病死率有显著性差异（P〈0．01）；各卒中组间DC≤4．5ms及DC〉4．5ms的发生率无显著性差异。结论DC≤2．5ms有望成为出血性脑血管病患者急性期发生恶性心律失常及猝死的预警指标。Objective To investigate the deceleration capacity of rate （DC） and its possible application in patients with acute hemorrhagic cerebral vascular disease. Methods A total of 128 patients with acute cerebral hemorrhage and pri- mary subarachnoid hemorrhage （SAH） who were divided into SAH group （ 48 cases ）, right basal ganglia hemorrhage group（30 cases ）, left basal ganglia hemorrhage group （28 cases） ）, non basal ganglia hemorrhage group（ 22 cases） and 80 normal control subjects underwent 24-hour dynamic electrocardiogram recordings at the first day they were in hospital. The computer automatically calculated the DC values and the values of heart rate variability （HRV）. Average heart rate, arrhythmic events, the changes of ST-T, cTnT increased, left ventricular ejection fraction （EF） and the clinical outcome and other clinical indicators were analyzed in each group of DC≤2.5 ms, DC 2.6- 4.5 ms, DC 〉 4.5 ms of Selected stroke patients. The incidence of DC ~〈 4.5 ms and DC 〉 4.5 ms were analyzed in each stroke group. The patients were followed up for 6 months and the mortality rate was calculated. Results Compared with the normal group, DC and HRV were significantly reduced in each stroke group （ P〈0.01 ）, and there is no significant difference among the stroke groups. Compared with group of DC 〉 4.5 ms , 24 h average heart rate, arrhythmic events, cTnT increased, the mortality rate had significantly difference （P〈0.01） in the group of DC ≤ 2.5 ms. There was no significant difference of the incidence of DC ≤4.5 ms and DC 〉 4.5 ms among each stroke group. Conclusion DC 〈~2.5 ms is expected to become early warning index of malignant arrhythmia and sudden death in patients with acute hemorrhagic cerebral vascular disease.

关 键 词：心血管病学 急性脑出血 蛛网膜下腔出血 心率减速力 自主神经 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R743.35[医药卫生—临床医学]