心率变异性与后循环梗死的关系及其对预后的评估价值  

Relationship between heart rate variability and posterior circulation cerebral infarction and its value in prognosis prediction

作　　者：巩莉[1] 马毓[1] 朱沂[1] 李红燕[1] 冯燕[1] 热那古力·阿不来提 Gong Li Ma Yu Zhu Yi Li Hongyan Feng Yan Re Naguli · A＇ bulaiti(Department of Neurology, People＇s Hospital of Xinfiang Uygur Autonomous Region, Urumqi 830001, China)

机构地区：[1]新疆维吾尔自治区人民医院神经内科,乌鲁木齐830001

出　　处：《中华神经科杂志》2016年第12期918-924,共7页Chinese Journal of Neurology

摘　　要：目的探讨后循环脑梗死患者心率变异性（heart rate variability，HRV）的变化特点及HRV对后循环梗死预后的预测价值。方法选取2015年3—11月就诊于我院神经内科并明确诊断为急性后循环梗死的54例连续住院患者，并选取96例连续前循环梗死患者作为对照组。采集所有受试者病史、全面的神经系统体检、实验室检查、辅助检查结果。采用24 h动态心电图分析后的HRV参数，探讨与前循环相比后循环梗死HRV的特异性指标；依据发病90 d时随访改良Rankin 量表（modified Rankin Scale，mRS）评分，将54例后循环梗死患者分为预后良好组（mRS 0～2分）35例，预后不良组（ mRS 3～6分）19例，通过对预后因素进行分析后得出HRV评估后循环梗死的预测价值。结果后循环梗死组HRV时域指标（ms）NN间期标准差（SDNN，93.32±23.51）、NN间期平均值的标准差（SDANN，82.57±18.40）、相邻NN间期差值均方的平方根（rMSSD，32.89±15.56）均较前循环梗死组（分别为109.66±52.08、107.41±61.58、42.60±23.24）减低（ t＝2.181、3.670、3.059，均P＜0.05），差异有统计学意义。后循环梗死组HRV频域指标总功率[（3373.28±1928.07） ms]、低频功率[（294.00±157.23） ms ]、低频功率／高频功率比（3.80±2.24）较前循环梗死组[分别为（2629.00±1352.43）、（233.61±134.53） ms和2.68±1.38]增高（ t＝2.762、2.481、3.426，均P＜0.05），差异有统计学意义。 HRV指标中SDNN（OR＝0.915，95％ CI 0.870～0.962， P＝0.000）、SDANN（OR＝0.921，95％CI 0.869～0.976， P＝0.005）、rMSSD（OR＝0.895，95％CI 0.831～0.963， P＝0.003）、低频功率／高频功率比（ OR＝1.564，95％ CI 1.052～2.326， P＝0.027）与后循环梗死90 d不良预后相关。结论后循环梗死较前循环梗死患者HRV减低，出现交感神经活性增加，提示后循环梗死患者更易出现自主神经功能受损。其中SDNN、SDANN、rMSSDObjective To investigate the characteristic of heart rate variability （ HRV） changes in patients with posterior circulation cerebral infarction and its value in prognosis prediction .Methods Fifty-four cases continuously diagnosed with acute posterior circulation cerebral infarction from March 2015 to November 2015 in the Department of Neurology of People′s Hospital of Xinjiang Uygur Autonomous Region were prospectively analyzed .At the same time , 96 cases of anterior circulation infarction were chosen as control group .General state of health and results of laboratory examinations and other auxiliary examinations of all patients were recorded .The 24-hour dynamic electrocardiogram was done to calculate the HRV .The characteristics of HRV changes in patients with posterior circulation cerebral infarction were compared with those with anterior circulation infarction .According to modified Rankin Scale （ mRS） score at onset of 90 days, posterior circulation infarction cases were divided into good prognosis group （mRS score 0 to 2） and poor prognosis group （ mRS score 3 to 6 ） .The correlation between HRV and the prognosis of posterior circulation infarction was analyzed .Results In patients with posterior circulation cerebral infarction , HRV time-domain parameters standard deviation of normal to normal interbeat intervals （ SDNN, （93.32 ±23.51）nbsp;ms）, root mean square of square sum of adjacent NN interval differences （SDANN, （82.57 ±18.40） ms）, root mean square of sussessive differences （ rMSSD, （ 32.89 ±15.56 ） ms ） were lower than those with anterior circulation infarction （（109.66 ±52.08） ms, （107.41 ±61.58） ms, （42.60 ±23.24） ms; t=2.181, 3.670, 3.059,all P〈0.05）; and HRV frequency domain parameters total power （（3 373.28 ± 1 928.07） ms）, low frequency （（294.00 ±157.23）ms）, low frequency/high frequency（LF/HF, 3.80 ± 2.24） were higher than those with anterior circulation infarction （（2 629.00 ±1 352.43） ms, （233

关 键 词：大脑梗塞 心率 自主神经系统 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]