存在睡眠呼吸异常的慢病患者呼吸影响心率变异性的初步分析  

Preliminary analysis of the influence of breathing on heart rate variability in chronically ill patients with sleep apnea

作　　者：周晴晴 孙兴国[2,3] 王继楠 台文琦 宋雅 郝璐 张也 葛万刚 李浩 张艳芳[3] 石超 徐凡 徐丹丹 谢友红[3] ZHOU Qing-qing;SUN Xing-guo;WANG Ji-nan;TAI Wen-qi;SONG Ya;HAO Lu;ZHANG Ye;GE Wan-gang;LI Hao;ZHANG Yan-fang;SHI Chao;XU Fan;XU Dan-dan;XIE You-hong(University Town Hospital Affiliated to Chongqing Medical University,Chongqing 401331;Fuwai Hospital,Chinese Academy of Medical Sciences/National Center for Cardiovascular Diseases/State Key Laboratory of Cardiovascular Diseases/Chinese Academy of Medical Sciences/Peking Union Medical College,Beijing 100037;The Affiliated Rehabilitation Hospital of ChongqingMedical University,Chongqing 400050;Hubei Provincial Hospital Of TCM,Wuhan 430061,China)

机构地区：[1]重庆医科大学附属大学城医院,重庆401331 [2]国家心血管病中心,中国医学科学院阜外医院,北京协和医学院心血管疾病国家重点实验室,心血管疾病国家临床医学研究中心,北京100037 [3]重庆医科大学附属康复医院,重庆400050 [4]湖北省中医院,武汉430061

出　　处：《中国应用生理学杂志》2021年第2期135-141,201,共8页Chinese Journal of Applied Physiology

基　　金：国家高技术研究发展计划(863计划)课题资助项目(2012AA021009);国家自然科学基金医学科学部面上项目(81470204);中国康复医疗机构联合重大项目基金(20160102);中国医学科学院国家心血管病中心阜外医院科研开发启动基金(2012-YJR02);首都临床特色应用研究与成果推广(Z161100000516127);北京康复医院2019-2021科技发展专项(2019-003);北京协和医学院教学改革项目(2018E-JG07);北京协和医学院-国家外国专家局外国专家项目(2015,2016,T2017025,T2018046,G2019001660);重庆市卫计委医学科研计划项目(2017MSXM090);重庆市科委社会事业与民生保障科技创新专项项目(cstc2017shmsA130063)。

摘　　要：目的:基于整体整合生理学医学理论提出的呼吸引起循环指标变异的假说,分析研究存在睡眠呼吸异常的慢病患者睡眠期间呼吸和心率变异之间的相关关系。方法:纳入存在睡眠呼吸异常且呼吸暂停低通气指数(AHI)≥15次/小时的慢病患者11例,签署知情同意书后完成标准化症状限制性极限运动的心肺运动试验(CPET)和睡眠呼吸监测,计算分析病人睡眠期间波浪式呼吸(OB)期与正常平稳呼吸期的呼吸鼻气流、心电图R-R间期心率变异的规律。结果:存在睡眠呼吸异常的慢病患者CPET峰值摄氧量(Peak VO_(2))和无氧阈(AT)为(70.8±13.6)%pred和(71.2±6.1)%pred;CPET有5例存在运动诱发的波浪式呼吸(EIOB),6例为呼吸不稳定,提示整体功能状态低于正常人。本组慢病患者AHI为每小时(28.8±10.0)次,睡眠呼吸异常总时间占睡眠总时间的比值为(0.38±0.25);OB周期的平均时间长度为(51.1±14.4)s。本组慢病患者正常平稳呼吸期的呼吸周期数与心率变异周期数的比值(B-n/HRV-B-n)为1.00±0.04,每个呼吸周期节律的心率变异平均幅度(HRV-B-M)为(2.64±1.59)bpm,虽然低于正常人(P<0.05),但却与无睡眠呼吸异常的慢病患者相似(P>0.05);HRV-B-M的变异度CV(HRV-B-M的SD/x)为(0.33±0.11),期间血氧饱和度(SpO_(2))虽略低,但并无明显规律性下降与上升。本组慢病患者的OB期间呼吸周期数与心率变异周期数(OB-B-n/OB-HRV-B-n)比值为(1.22±0.18),OB期每个呼吸周期节律的心率变异平均幅度(OB-HRV-B-M)为(3.56±1.57)bpm及其变异度(OB-CV=OB-HRV-B-M的SD/x)为(0.59±0.28),每个OB周期节律的心率变异平均幅度(OB-HRV-OB-M)为(13.75±4.25)bpm,OB期间低通气时SpO_(2)出现明显的下降,OB期间SpO_(2)平均变异幅度(OB-SpO_(2)-OB-M)为(4.79±1.39)%,OB期的OB-B-n/OB-HRV-B-n比值、OB-HRVOB-M比其正常平稳呼吸期对应指标显著增大(P<0.01)。OB-HRV-B-M虽然与正常平稳呼吸期HRV-B-M相比差异无统计学意义(P>0.05),但Objective:Based on the hypothesis that respiration causes variability of circulatory indicators proposed by the holistic integrated physiology and medicine theory,the correlation between respiration and heart rate variability during sleep in chronically ill patients with abnormal sleep breathing is analyzed.Methods:Eleven chronically ill patients with abnormal sleep breathing and apneahypopnea index(AHI)≥15 times/hr are recruited.After signing the informed consent,they completed the standardized symptomatic restrictive extreme exercise cardiopulmonary exercise testing(CPET)and sleep breathing monitoring Calculate and analyze the rules of respiratory nasal airflow and ECG RR interval heart rate variability during the oscillatory breathing(OB)phase and the normal steady breathing phase of the patient during sleep,and use the independent sample t test to compare with normal people and no sleep breathing abnormalities in the same period in this laboratory.Of patients with chronic diseases are more similar and different.Results:The peak oxygen uptake and anaerobic threshold(AT)of CPET in chronic patients with abnormal sleep apnea were(70.8±13.6)%Pred and(71.2±6.1)%Pred;5 cases of CPET had exercise induced oscillatory breathing(EIOB),6 An example is unstable breathing,which indicates that the overall functional status is lower than normal.In this group of patients with chronic diseases,AHI(28.8±10.0)beats/h,the ratio of the total time of abnormal sleep breathing to the total time of sleep(0.38±0.25);the length of the OB cycle(51.1±14.4)s.The ratio(Bn/HRV-B-n)of the number of breathing cycles in the normal and steady breathing period to the number of heart rate variability cycles in this group of patients with chronic diseases is 1.00±0.04,and the CV(SD of HRV-B-S/x)is(0.33±0.11),blood oxygen saturation(SpO_(2))did not decrease significantly,the average amplitude of heart rate variability(HRV-B-M)of each respiratory cycle rhythm was(2.64±1.59)bpm,although it was lower than normal people(P<0.05),But it was simi

关 键 词：整体整合生理学医学理论 波浪式呼吸 心率变异性 

分 类 号：R332[医药卫生—人体生理学]