慢性心率增快在原发性高血压患者中的临床价值探讨  

Clinical value of chronic heart rate increase in patients with essential hypertension

作　　者：黄东芬[1] 韦振东[1] 兰元元[1] 韦春苗 韦慧君 

机构地区：[1]广西河池市人民医院心电诊断科,547000

出　　处：《齐齐哈尔医学院学报》2016年第10期1268-1272,共5页Journal of Qiqihar Medical University

摘　　要：目的探讨慢性心率增快、血压昼夜节律、心率震荡(HRT)和心率变异性(HRV)时阈指标(SDNN)在单纯高血压(Essential hypertension,EH)及高血压合并2型糖尿病患者(Type 2 Diabetes Mellitus,T2DM)中的变化特点以及它们之间的关系。方法选择EH 90例、高血压合并2型糖尿病患者(EH&T2DM)53例和健康人50例分别为EH组、EH&T2DM组和对照组。行24小时动态心电、血压及血糖同步监测(对照组仅行心电、血压监测),根据动态心电图记录资料,获取HRT的两个参数震荡初始值(TO)和震荡斜率值(TS)以及HRV的全部NN间期的标准差(SDNN)、24小时平均心率,比较各组间的差别。依据动态血压参数-夜间血压下降率分为杓型血压组及非杓型血压组,并分析慢性心率增快与血压昼夜节律、TO、TS、SDNN之间的关系。结果 EH&T2DM组非杓型血压、慢性心率增快及TO、TS、SDNN值异常的阳性检出率均高于单纯EH组及对照组,组间比较差异有统计学意义;非杓型血压组(68.4%)的TS(2.03±1.71)、SDNN(80.91±12.65)明显低于杓型血压组(3.56±1.93)、(125.68±30.12);TO值(2.98±2.05)、平均心率(91.18±6.24)明显高于杓型血压组(-0.36±0.73)、(62.95±5.59);EH&T2DM组TO与SDNN呈负相关,与慢性心率增快呈正相关;TS与慢性心率增快呈负相关,而与SDNN呈正相关;三组患者夜间血压下降率与TO、TS、SDNN及慢性心率增快相关性有统计学意义。结论慢性心率增快与血压昼夜节律波动减弱或消失、HRT以及HRV异常相关,提示慢性心率增快、HRT及血压昼夜节律减弱可以作为早期发现高血压特别是合并有2型糖尿病患者心脏自主神经功能紊乱的一个有效的可靠无创指标。Objective To explore the changes of chronic heart rate increase,circadian rhythm,HRT,SDNN in patients with essential hypertension and the relationships between them,as well as in hypertensive patients with type 2 diabetes. Methods Essential hypertension group： 90 cases,EHT2DM group： 53 cases and50 cases of healthy people as a control group. They underwent 24 hours Holter examination,simultaneous monitoring of blood pressure and blood sugar（ The control group underwent ECG,blood pressure monitoring）,according to Holter recording data,we got to know initial shock value parameter（ TO） and turbulence slope value（ TS） of HRT and（ SDNN）,24 hours average heart rate,then compared the difference between groups.According to ambulatory blood pressure parameters-Nighttime blood pressure drop rate was divided into dipper blood pressure group and non-dipper blood pressure group,we analyzed the relationship between chronic heart rate increasing and blood pressure circadian rhythm,TO,TS,SDNN. Results 1The positive detection rate of Non-dipper blood pressure,chronic heart rate increasing and TO,TS,SDNN value in EH T2 DM group was higher than that in EH group and control group,the difference between groups was statistically significant; 2The TS（ 2. 03 ± 1. 71）,SDNN（ 80. 91 ± 12. 65） in the Non-dipper blood pressure group（ 68. 4%） was significantly lower than that in the dipper blood pressure group（ 3. 56 ± 1. 93）,（ 125. 68 ± 30. 12）; TO value（ 2. 98 ± 2. 05）,mean heart rat e（ 91. 18 ± 6. 24） was significantly higher than that in the dipper blood pressure group（-0. 36 ±0. 73）,（ 62. 95 ± 5. 59）; 3 TO in the EH T2 DM group is negatively correlated with SDNN,positively correlated with chronic heart rate increase; TS was negatively correlated with chronic heart rate increase,positively correlated with SDNN; 4There was significant correlation between nighttime blood pressure drop rate and TO,TS,SDNN and chronic heart rate increase of three groups. Conclusions Chronic heart

关 键 词：慢性心率增快 高血压合并2型糖尿病 窦性心率震荡 血压昼夜节律 

分 类 号：R544.1[医药卫生—心血管疾病]