老年衰弱患者的心脏自主神经功能研究  

Cardiac autonomic nerve function in elderly patients with frailty

作　　者：曾学寨[1] 梁耀丹 石婧[2] 甘宇 孙宁[1] 果迪 崔玲玲 周济红 李雪迪 贾娜[1] 王华[1] 刘德平[1] 杨杰孚[1] Zeng Xuezhai;Liang Yaodan;Shi Jing;Gan Yu;Sun Ning;Guo Di;Cui Lingling;Zhou Jihong;Li Xuedi;Jia Na;Wang Hua;Liu Deping;Yang Jiefu(Department of Cardiology,Beijing Hospital,Beijing 100730,China;Department of Geriatric Medicine,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院心内科,100730 [2]北京医院老年医学部国家老年医学中心中国医学科学院老年医学研究院,100730

出　　处：《中华全科医师杂志》2020年第10期908-912,共5页Chinese Journal of General Practitioners

基　　金：北京市科委基金面上项目(D181100000218003);中国医学科学院中央级公益性科研院所基本科研业务费专项(2019PT320013);中国医学科学院医学与健康科技创新工程(2018-I2M-1-002)。

摘　　要：目的评估老年衰弱患者心脏自主神经功能。方法选择2018年9月至2019年8月在北京医院住院的年龄≥65岁的患者,应用临床衰弱分级进行衰弱评估,应用动态心电图进行窦性心率震荡分析评估心脏自主神经功能。结果本研究纳入住院老年患者共129例,男性75例(58.1%),平均年龄77.5岁,范围65.0~92.1岁。衰弱患者53例,非衰弱患者76例,衰弱组年龄[(80.5±5.5)岁]大于非衰弱组[(75.3±6.2)岁],衰弱组高血压[84.9%(45/53)]、心力衰竭[32.1%(17/53)]及外周血管疾病[32.1%(17/53)]比例高于非衰弱组[65.8%(50/76),1.3%(1/76),17.1%(13/76)],差异均有统计学意义(t=5.001,χ2值分别为5.879、24.606、3.921;均P<0.05)。与非衰弱组比,衰弱组震荡初始(TO)[-0.05(-0.92,0.82)%比-0.74(-1.58,0)%;Z=2.616,P=0.009]更高、震荡斜率(TS)[2.34(1.30,5.00)ms/RR比4.34(2.66,6.39)ms/RR;Z=-3.048,P=0.002]更低,衰弱组TO异常[49.1%(26/53)比26.3%(20/76),χ2=7.038,P=0.008]及TS异常[34.7%(29/53)比21.0%(16/76),χ2=15.579,P<0.001]发生率高于非衰弱组。多因素logistic回归分析显示TO异常(OR=2.970,P=0.010,95%CI:1.300~6.785)及TS异常(OR=3.618,P=0.003,95%CI:1.565~8.364)与衰弱相关。结论老年衰弱患者心脏自主神经功能受损,迷走神经张力降低。Objective To assess the cardiac autonomic nervous function in elderly patients with frailty.Methods Patients aged≥65 years old admitted in Beijing Hospital from September 2018 to August 2019 were enrolled in this study.Clinical frailty score was used to assess the frailty.The cardiac autonomic modulation was evaluated by sinus heart rate turbulence analysis through 24 h electrocardiogram recording.Results A total of 129 elderly patients were finally enrolled in this study with a mean age of(77.5±6.4)years,58.1%of them were male.There were 53 patients in frail group and 76 patients in non-frail group.The age of the frailty group was significantly higher than that of the non-frailty group[(80.5±5.5)vs.(75.3±6.2)];the prevalence of hypertension[84.9%(45/53)],heart failure[32.1%(17/53)]and peripheral vascular diseases[32.1%(17/53)]in the frailty group was significantly higher than that in the non-frailty group[65.8%(50/76),1.3%(1/76),17.1%(13/76);t=5.001,χ2=5.879,24.606,3.921;all P<0.05].Compared with non-frailty group,turbulence onset(TO)[-0.05(-0.92,0.82)%vs.-0.74(-1.58,0)%;Z=2.616,P=0.009]was significantly higher in frailty group,while turbulence slope(TS)[2.34(1.30,5.00)ms/RR vs.4.34(2.66,6.39)ms/RR;Z=-3.048,P=0.002]was significantly lower.The rate of TO abnormality[49.1%(26/53)vs.26.3%(20/76),χ2=7.038,P=0.008]and TS abnormality[34.7%(29/53)vs.21.0%(16/76);χ2=15.579,P<0.001]in the frailty group was significantly higher than that in the non-frailty group.Multivariate logistic regression analysis showed that TO abnormality(OR=2.970,P=0.010,95%CI:1.300-6.785)and TS abnormality(OR=3.618,P=0.003,95%CI:1.565-8.364)were correlated with frailty.Conclusion Cardiac autonomic nerve function may be impaired in elderly frail patients,and decreased vagal nerve tension may be presented.

关 键 词：老年人 自主神经系统 衰弱 心率震荡 

分 类 号：R592[医药卫生—老年医学]