老年多病因心衰的病因和心率变异性及平均心率分析  

Analysis of pathogeny,heart rate variability and the average heart rate in elderly patients with multifactor heart failure

作　　者：王雪玲 Wang Xue-ling(Department of Cardiovascular Medicine,Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Beijing University of Chinese Medicine,Beijing 100039,China)

机构地区：[1]北京中医药大学附属中西医结合医院心血管内科,北京100039

出　　处：《实用心电学杂志》2018年第3期185-188,共4页Journal of Practical Electrocardiology

摘　　要：目的探讨老年多病因心衰加重的病因和心率变异性及24 h平均心率对老年多病因心衰的评定价值。方法选取2014年6月至2017年9月于北京市中西医结合医院住院并行动态心电图检查,患两种以上基础疾病(高血压、冠心病、糖尿病)的老年患者123例为病例组。根据纽约心脏病学会(NYHA)分级标准,病例组分为心功能正常组23例,心功能Ⅰ级组19例,心功能Ⅱ级组59例,心功能Ⅲ~Ⅳ级组22例。同期选择30例健康老年人为对照组。对比分析不同级别心衰患者的病因、心率变异性时域指标和24 h平均心率。结果与心功能正常组、心功能Ⅰ级组、心功能Ⅱ级组比较,陈旧性心肌梗死比例在心功能Ⅲ~Ⅳ级组最高,差异有统计学意义(P<0.05)。病例组SDNN、SDANN、SDNN Index、r MSSD、p NN50低于对照组(P<0.05),24 h平均心率高于对照组(P<0.05)。心功能正常组、心功能Ⅰ级组和心功能Ⅱ级组进行组间两两比较,SDNN、SDANN、SDNN Index、r MSSD、p NN50和24 h平均心率差异无统计学意义(P>0.05);心功能Ⅲ~Ⅳ级组和心功能正常组、心功能Ⅰ级组和心功能Ⅱ级组比较,SDNN、SDANN、SDNN Index、r MSSD、p NN50均降低(P<0.05),24 h平均心率升高(P<0.05)。结论陈旧性心肌梗死是老年多病因心衰加重的主要病因,心率变异性和24 h平均心率对评价心功能Ⅲ~Ⅳ级的老年多病因心衰有较好的价值。Objective To explore the causes of worsened multifactor heart failure（ MHF）,and to determine the value of heart rate variability（ HRV） and the average heart rate within 24 hours in evaluating MHF in elderly people. Methods We selected 123 elderly patients with at least two underlying diseases（ including hypertension,coronary heart disease and diabetes） as case group,and they had been admitted in the Hospital of Integrated Traditional Chinese and Western Medicine in Beijing from June 2014 to September 2017 undergoing ambulatory electrocardiography examination. According to NYHA cardiac function classification,case group were further divided into normal heart function group（ 23 cases）,NYHA grade Ⅰ group（ 19 cases）,NYHA grade Ⅱ group（ 59 cases） and NYHA grade Ⅲ-Ⅳgroup（ 22 cases）. Thirty healthy old people were simultaneously taken as control group. The pathogeny,HRV time domain indexes and the average heart rate within 24 hours were comparatively analyzed among the heart failure patients at different NYHA gradings. Results In the NYHA grade Ⅲ-Ⅳgroup,the incidence rate of old myocardial infarction was higher than that in other case subgroups,with statistically significant difference（ P 〈 0. 05）. The HRV indexes of SDNN,SDANN,SDNN Index,r MSSD and p NN50 in case group were lower than those in the control group（ P 〈 0. 05） while the average heart rate within 24 hours was higher（ P 〈0. 05）. Pairwise comparison was made among normal heart function group,NYHA grade Ⅰ and Ⅱ groups,and it was found that SDNN,SDANN,SDNN Index,r MSSD,p NN50 and the average heart rate within 24 hours did not vary significantly（ P 〉 0. 05）. In the NYHA grade Ⅲ-Ⅳ group,SDNN,SDANN,SDNN Index,r MSSD and p NN50 were lower than those in the normal heart function group（ P 〈 0. 05） while the average heart rate within 24 hours was significantly higher（ P 〈 0. 05）. In the NYHA grade Ⅰ group,the above HRV indexes also decreased and the average heart rate increased if co

关 键 词：多病因心衰 心率变异性 平均心率 

分 类 号：R540.41[医药卫生—心血管疾病]