高血压患者心率与心率昼夜节律分析的意义  

Analysis of clinical significance of heart rate and heart rate of circadian rhythm in hypertensive patients

作　　者：彭瑞华[1] 白梅[1] 

机构地区：[1]太原市人民医院,030001

出　　处：《临床心电学杂志》2017年第1期31-33,共3页Journal of Clinical Electrocardiology

摘　　要：目的探讨高血压患者杓型心率、非杓型心率、静息心率、平均心率、夜间心率、日间心率的动态变化与心率变异的关系及对预后的影响。方法随机选取原发性高血压患者206例。按昼间均值-夜间均值/昼间均值≥10%者定为杓型心率组,<10%者定为非杓型心率组。全部做24h动态心电监测,采集静息心率(RHR)、平均心率(RHR)、夜间心率(NHR)、昼间心率(DHR)、心率变异的低频(LF)、高频(HF)值以及SDNN,rMSSD,PNN50。结果杓型心率组心率变异昼夜比:夜间LF、HF明显高于昼间(p<0.05),但LF/HF比值昼>夜。非杓型心率组与杓型HR组比:昼间LF减低,夜间LF、HF均显著减低(p<0.05),RHR、AHR、NHR均显著增高(p<0.001,p<0.01)。SDNN,rMSSD,PNN50均显著减低(p<0.05,p<0.005)。结论高血压杓型心率患者的心率加快是自主神经功能调节障碍所致,非杓型心率患者的心率加快是迷走神经功能过度抑制,交感神经功能过度激活的结果,提示自主神经功能严重受损,预后不良。Objective To investigate hypertension patients with dipper heart rate, non-dipper heart rate, resting heart rate （RHR）, average heart rate （AHR）, night heart rate （NHR）, day heart rate （DHR） , analyse the relationship between their dynamic changes and heart rate variability, clear its effect on prognosis. Methods 206 cases of patients with hypertension were random chosen.According to value of ＂the day heart rate （DHR）-the night heart rate （NHR） / the day heart rate （NHR）＂, patients were devided into the dipper heart rate group （≥ 10%） and the non-dipper heart rate group （〈 10%）. All the patients were synchronously monitored by 24-hour ambulatory ECG. All the patients were collected RHR, AHR, NHR, DHR,the quantitative index of heart rate variability：Low-frequency value （LF） and High-frequency （HF）, SDNN, rMSSD, PNN50 for statistical analysis. Results The dipper heart rate group nocturnal sympathetic and vagus nerve are dominant,Significantly higher than during the day, and the difference was significant（p 〈0.05 ）, hut the result of LF/HF indicate the day〉the night. Non-dipper heart rate group compared to dipper heart rate group： LF by day decreased,and LF, HF were significantly lower at night （p 〈0.05）. RHR, AHR, NHR were significantly higher （p 〈0.001, p 〈0.01）. SDNN,rMSSD,PNN50 were significantly lower （p 〈 0.05, p 〈0.005）. Conclusions Heart rate of hypertensive patients with dipper heart rate were increased due to the dysregulation of the autonomic nervous system function.Heart rate of hypertensive patients with non-dipper heart rate were increased due to excessive inhibition of the vagus nerve function and enhanced sympathetic function.This suggests if the autonomic nervous function is severely damaged in hypertension patients then the prognosis is poor.

关 键 词：高血压 心率昼夜节律 心率变异 

分 类 号：R544.1[医药卫生—心血管疾病] R540.41[医药卫生—内科学]