胸痹患者不同中医证型心率变异性分析  

Analysis of heart rate variability in patients with chest pain accompanied by different traditional Chinese medicine syndromes

作　　者：俞志刚[1] 汤诺[1] 孙丽华[1] 曹敏[1] 方邦江[1] 高继梅[1] 魏娜[1] 

机构地区：[1]上海中医药大学附属龙华医院,上海200032

出　　处：《中国中西医结合急救杂志》2017年第2期115-118,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：上海市科技计划项目（14401972501）

摘　　要：目的探讨胸痹患者不同中医证型与心率变异性（HRV）的关系，为胸痹患者临床辨证提供参考。方法采用前瞻性研究方法，选择上海中医药大学附属龙华医院2015年1月至2016年10月住院的胸痹患者117例为研究对象，按中医证型分为气虚血瘀证、心血瘀阻证、气阴两虚证、胸阳不振证、痰瘀阻滞证和气滞血瘀证，比较不同中医证型的性别分布及不同性别HRV时域指标正常心动周期R—R间期标准差的平均数（ASDNN）、24hR—R间期标准差（SDNN）、24h每5min正常R—R间期标准差（SDANN）、24h相邻R—R间期差值的均方根（RMSSD）的差异。以同期本院123例健康体检者为健康对照组，比较健康对照组与不同中医证型胸痹患者HRV各时域参数的差异。结果胸痹患者中以心血瘀阻证所占比例最大（35例，占29．9％），而气滞血瘀证所占比例最小（5例，4．3％）；胸痹患者气虚血瘀证（17例比14例）、心血瘀阻证（23例比12例）、胸阳不振证（6例比2例）及气滞血瘀证（3例比2例）中女性较男性多，气阴两虚证（20例比12例）和痰瘀阻滞证（4例比2例）中男性较女生多。女性患者SDNN、SDANN、ASDNN和RMSSD水平较男性显著降低[ms：分别为87．1（63．6，106．2）比135．0（69．7，116．0），66．8（33．4，80．8）比103．4（39．7，135．4），124．7（88．0，143．4）比167．0（90．5，230．1），84．0（22．5，132．6）比152．4（31．4，240．0），均P〈0．05]。各中医证型胸痹患者的SDANN均明显低于健康对照组，且以气虚血瘀证、心血瘀阻证和胸阳不振证患者降低更为明显（ms：74．86±25．69、80．39±20．53、70．97±23．53比131．30±34．70，均P〈0．05）；气阴两虚证患者SDNN均较心血瘀阻证、痰瘀阻滞证、气滞血瘀证明显升高（ms：181．25±65．20比97．88±23．61、84．28±22．34、89．93±8．43，均P〈0．05），气阴Objective To explore the correlations between different traditional Chinese medicine （TCM） syndromes and the heart rate variability （HRV） accompanying patients with chest pain, and to provide a reference for clinical syndrome differentiation in such patients. Methods A prospective study was conducted. One hundred and seventeen patients with chest pain admitted into Longhua Hospital Affiliated to Shanghai University of TCM from January 2015 to October 2016 were assigned in a study object, and according to the differentiation of TCM syndromes, they were divided into syndrome of qi deficiency with blood stasis, the blood stagnation of heart, the deficiency of qi and yin, suppression of the chest yang, phlegm and blood stasis, qi-stagnancy and blood stasis syndromes. In the same period, 123 healthy people having undergone physical examination were assigned in a normal control group. The time domain indexes of HRV were recorded by dynamic electrocardiogram, and the indexes of the normal control group were compared to those of patients with different TCM syndrome in study group. The gender distribution in different TCM syndromes and various HRV time domain indexes were observed. The normal cardiac cycle time domain indexes were as follows： the average standard deviation of R-R interval （ASDNN）, 24 hours standard deviation of R-R interval （SDNN）, 24 hours standard deviation of average value of R-R interval in every 5 minutes （SDANN）, 24 hours the mean square root of difference values between adjacent R-R intervals （RMSSD） were observed in both groups. Results The chest pain patients accompanied by blood stagnation of heart were accounting for the largest proportion （35 cases, 29.9%）, and accompanied by qi-stagnancy and blood stasis, the smallest proportion （5 cases, 4.3%） in the study group; the numbers of patients with qi deficiency with blood stasis syndrome （17 cases vs. 14 cases）, blood stagnation of heart （23 cases vs. 12 cases）, suppression of the chest yang （6 cases vs.

关 键 词：胸痹 中医辨证 心率变异性 

分 类 号：R544.1[医药卫生—心血管疾病]