先天性心脏病介入治疗前后心律失常及心率变异性变化与术后心功能的相关性分析  

Correlation analysis between arrhythmia and heart rate variability before and after interventional therapy for congenital heart disease and the rehabilitation of cardiac function after operation

作　　者：魏传菊 任长明[1] 庄海峰[1] 李青伟[1] 孟锋 WEI Chuan-ju;REN Chang-ming;ZHUANG Hai-feng;LI Qing-wei;MENG Feng(Department of Catheterization,Xuzhou Central Hospital,Jiangsu Xuzhou 221009,China)

机构地区：[1]徐州市中心医院导管室

出　　处：《中国医刊》2020年第2期159-162,共4页Chinese Journal of Medicine

摘　　要：目的分析先天性心脏病介入治疗前后心律失常及心率变异性(heart rate variability,HRV)变化与术后心功能的相关性。方法选取2016年3月至2019年3月在徐州市中心医院接受介入治疗的268例先天性心脏病患者,观察患者治疗前后心律失常的类型和检出率,HRV的时域指标[正常R-R间期平均值(normal R-R interval average,R-R)、相邻正常心动周期≥50ms的R-R间期差值构成比(composition ratio of R-R interval difference between adjacent normal cardiac cycles≥50ms,PNN50%)、24h内每5min节段R-R间期均值标准差(standard deviation of mean R-R interval per 5min segment within 24h,ASDNN)、24h内每5min节段R-R间期平均标准差(mean standard deviation of R-R interval per 5min segment within 24h,SDANN)、24h内R-R间期标准差(standard deviation of R-R interval within 24h,SDNN)、相邻正常R-R间期标准差(adjacent normal R-R interval standard deviation,rMSSD)]及频域指标[总功率(total power,TP)、低频功率(low frequency power,LF)、高频功率(high frequency power,HF)、低频功率/高频功率比值(LF/HF)]的变化,并分析其与术后心功能的相关性。结果治疗后患者心律失常的总检出率为69.03%,明显高于治疗前的51.49%,差异有显著性(P<0.05)。治疗后患者HRV时域和频域指标与治疗前比较明显改善(P<0.05)。心功能Ⅲ级和Ⅳ级患者HRV的时域和频域指标与心功能Ⅰ级和Ⅱ级患者比较差异有显著性(P<0.05)。相关分析显示,心律失常检出率、R-R、PNN50%、ASDNN、SDANN、SDNN、rMSSD、TP、LF、HF、LF/HF与患者术后心功能呈明显相关关系(Spearman等级相关系数Rs=-0.361、0.536、0.416、0.468、0.408、0.438、0.368、0.514、0.317、0.386、0.421,P<0.05),而心律失常类型与患者术后心功能无明显相关性(Rs=0.053,P=0.518)。结论先天性心脏病介入治疗后心律失常发生率及HRV的时域和频域指标明显增高,并与患者术后心功能相关,可作为判定心功能康复的参考指标�Objective To analyze the correlation between the changes of arrhythmia and heart rate variability before and after interventional therapy of congenital heart disease and the rehabilitation of cardiac function after operation.Method 268 patients with congenital heart disease admitted to our hospital from March 2016 to March 2019 were selected as subjects of study.Observe the type and detection rate of arrhythmia before and after treatment,the time domain index of HRV(normal RR interval average(RR),the ratio of RR interval difference between adjacent normal cardiac cycles≥50ms composition ratio of RR interval difference between adjacent normal cardiac cycles≥50ms,PNN50%),standard deviation of mean RR interval per 5min segment within 24h(ASDNN),mean standard deviation of R-R interval per 5min segment within 24h(SDANN),standard deviation of mean RR interval within 24h(SDNN),adjacent normal RR interval standard deviation(rMSSD)and frequency domain indicators total power(TP),low frequency power(LF),high frequency power(HF),The changes of low-frequency power/high-frequency power(LF/HF)were analyzed and their correlation with postoperative cardiac function was analyzed.Result The total detection rate of arrhythmia after treatment was 69.03%,which was significantly higher than that before treatment(51.49%,P<0.05).The HRV time-domain and frequency-domain indicators of patients after treatment were significantly improved compared with those before treatment(P<0.05).The HRV time domain and frequency domain indexes of patients with grade III and IV cardiac function were significantly different from those of patients with grade I and II cardiac function(P<0.05).The detection rate of arrhythmia,R-R,PN50%,ASDNN,SDANN,DE,rMSSD,TP,LF,HF,LF/HF were correlated with the recovery of cardiac function after operation(Spearman grade correlation coefficient was-0.361,0.536,0.416,0.468,0.408,0.438,0.368,0.514,0.317,0.386,0.421,respectively).Conclusion The incidence of arrhythmia was significantly increased after interventional therapy

关 键 词：先天性心脏病 介入治疗 心律失常 心率变异性 心功能康复 

分 类 号：R541.1[医药卫生—心血管疾病]