Ⅰ-Ⅱ期高血压病患者昼夜长程心率功率谱改变及依那普利的干预影响  

Circadian Rhythm of Cardiac Autonomic Nervous Activity and The Effect of Enalapril In Essential Hypertension

作　　者：刘勇[1] 杨涛[1] 陈家香[2] 陈运贞 

机构地区：[1]四川省自贡市第三人民医院,四川自贡643020 [2]重庆医科大学附属一医院

出　　处：《高血压杂志》2002年第5期446-451,共6页Chinese Journal of Hypertension

摘　　要：目的　研究高血压患者心脏自主神经活性 (A)昼夜节律改变及依那普利对其干预影响。方法　对 30例原发性高血压Ⅰ -Ⅱ期患者治疗前后和 30例健康对照组进行心功率谱 (HRPS)指标及昼夜节律分析 ,以及三维立体HRPS图制作。结果⑴、Ⅰ -Ⅱ期高血压组TP、VLF、LF、HF在深夜 3～ 4Am明显高于对照组 (P <0 0 5 ) ,而LF HF比值在各时段两组差异均不显著 (P >0 0 5 ) ;⑵、治疗后对白昼HRPS指标无显著影响 (P >0 0 5 ) ,而深夜 3～ 4Am时段TP、VLF、LF、HF分别下降 2 5 .2 % (P <0 0 5 )、2 7.1% (P <0 0 5 )、16 .8% (P >0 0 5 )、2 5 0 % (P <0 0 5 ) ;(3)、正常人 ,高血压Ⅰ -Ⅱ期患者 ,高血压合并冠心病、糖尿病、脑梗塞有各自特征性三维立体HRPS图表现。结论⑴、Ⅰ -Ⅱ期高血压患者夜间心脏交感和迷走神经活性均明显增强 ,该发现提示早期高血压自主神经活性有代偿性增强的病生改变 ;⑵、依那普利 4周治疗能改善高NA血压病人夜间增强的心脏自主神经活性的峰值 ;(3)心功率谱分析的确具有研究、应用临床、评价心脏自主神经功能的实用价值 ,三维立体图特征明显 ,可望成为新型影像技术应用于临床。Objective To Study the circadian rhythm of cardiac autonomic nervous activity(ANA) in essential hypertension and evaluate the effect of enalapril treatment. Methods 24 hour heart rate power spectral analysis(HRPSA) and 3D HRPS graph were performed in 30 patients with stage Ⅰ toⅡ essential hypertension(EHⅠ Ⅱ)?and 30 healthy normotensives. Results (1) In EH Ⅰ-Ⅱ group, TP? VLF? LF and HF were increased apparently(P<0 05) at late night (3～4 Am) than those of normotensive group, with no changes in LF/HF ratio ( P >0 05) between two groups. (2) Enalapril reduced TP( P <0 05)? VLF( P <0 05)?LF( P >0 05)?HF( P <0 05) by 25.2%, 27.1%, 16.8%, and 25 0%, respectively at late night(3～4 Am) while no effect was manifested during daytime. (3) 3D HRPS graph in showed specific characteristics in various patients. Conclusions (1) Sympathetic and parasympathetic activities were increased at late night in patients with EH Ⅰ Ⅱ,suggesting enhanced compensation of ANA was presented in the early stage of EH, (2) Enalapril decrease the peak values of ANA at night after 4 weeks treatment( see 3 d HRPS graph).

关 键 词：Ⅰ-Ⅱ期 高血压 心率功能谱分析 自主神经活性 昼夜节律 依那普利 

分 类 号：R544.1[医药卫生—心血管疾病]