186例瓣膜病患者肺动脉收缩压预测自主神经兴奋的前瞻性研究  

Predictive value of systolic pulmonary artery pressure on autonomic nerve excitation in 186 patients with valvular disease:A prospective study

作　　者：岳凤捷 金岩 张誉籍 辛芳冉 王辉山 YUE Fengjie;JIN Yan;ZHANG Yuji;XIN Fangran;WANG Huishan(Xiangyang Central Hospital,Affiliated Hospital of Hubei University of Arts and Science,Xiangyang,441021,Hubei,P.R.China;Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang,110016,P.R.China)

机构地区：[1]湖北文理学院附属医院,襄阳市中心医院,湖北襄阳441021 [2]北部战区总医院心血管外科,沈阳110016

出　　处：《中国胸心血管外科临床杂志》2024年第2期276-282,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(82070239)。

摘　　要：目的探讨瓣膜病患者的肺动脉收缩压(systolic pulmonary artery pressure,SPAP)对自主神经兴奋的预测价值,为临床干预方案的制定提供参考。方法前瞻性收集2020年8月28日—2021年2月3日北部战区总医院需要手术治疗的瓣膜病患者,根据术前7 d长程动态心电图平均心率变异性(heart rate variability,HRV)的正常心动周期标准差(standard deviation of normal-to-normal R-R intervals,SDNN)将患者分为3组,即交感神经(sympathetic nerve,SE)组(SDNN≤50 ms)、平衡组(50 ms<SDNN<100 ms)和副交感神经(parasympathetic nerve,PSE)组(SDNN≥100 ms),分析各组超声心动图指标变化与自主神经兴奋之间的相关性,并探究其预测价值。结果共纳入186例患者,其中男108例、女78例,平均年龄(55.92±11.99)岁。SE组26例,平衡组104例,PSE组56例。SE组的左房前后径(left anteroposterior diameter,LAD)、左室舒张末期内径、二尖瓣E峰/A峰(Em/Am)、左室舒张末期容积、左室收缩末期容积及肺动脉收缩压(systolic pulmonary artery pressure,SPAP)均大于平衡组(P<0.05),而三尖瓣A峰(At)、左室射血分数(left ventricular ejection fraction,LVEF)均小于平衡组(P<0.05);平衡组的LAD、Em/Am明显大于PSE组(P<0.05)。多因素分析发现SE组患者与平衡组比较,其At降低(右房收缩功能降低)、LVEF降低、SPAP增高(P值分别为0.04、0.04和0.00);当瓣膜病患者HRV增高副交感神经兴奋时,出现LAD正常的Em/Am降低(左房功能和/或左室舒张功能降低)。皮尔逊分析显示,SPAP与SDNN之间呈线性负相关,系数为−0.348,表明SPAP越高,HRV越低,交感神经越兴奋。受试者工作特征曲线显示当SPAP≥45.50 mm Hg(1 mm Hg=0.133 kPa)时,诊断瓣膜病患者交感神经兴奋的敏感度为84.60%,特异度为63.70%。结论副交感神经兴奋是疾病早期表现,常伴有左房功能和/或左室舒张功能降低;交感神经兴奋可伴随SPAP升高及左室和右房的收缩功能降低,其中SPAP对瓣膜病患者Objective To explore the predictive value of systolic pulmonary artery pressure(SPAP)on autonomic nerve excitation in patients with valvular disease,so as to provide reference for the formulation of clinical intervention plans.Methods The clinical data of patients with valvular disease who received surgical treatment in the General Hospital of Northern Theater Command from August 28,2020 to February 3,2021 were prospectively collected.According to the standard deviation of normal-to-normal R-R intervals(SDNN)of the heart rate variability(HRV)of the long-range dynamic electrocardiogram(ECG)7 days before the operation,the patients were divided into three groups:a sympathetic dominant(SE)group(SDNN≤50 ms),a balance group(50 ms<SDNN<100 ms)and a parasympathetic dominant(PSE)group(SDNN≥100 ms).The correlation between the changes of echocardiographic indexes and autonomic nerve excitation among the groups and the predictive values were analyzed.Results A total of 186 patients were enrolled,including 108 males and 78 females aged 55.92±11.99 years.There were 26 patients in the SE group,104 patients in the balance group,and 56 patients in the PSE group.The left anteroposterior diameter(LAD),left ventricular end diastolic inner diameter,ratio of peak E to peak A of mitral valve(Em/Am),left ventricular end diastolic volume,left ventricular end systolic volume and SPAP in the SE group were higher than those in the balance group(P<0.05),while peak A of tricuspid valve(At)and left ventricular ejection fraction(LVEF)were lower than those in the balance group(P<0.05).The LAD and Em/Am in the balance group were significantly higher than those in the PSE group(P<0.05).Multivariate analysis showed that patients in the SE group had lower At(right atrial systolic function declines),lower LVEF and higher SPAP than those in the balance group(P=0.04,0.04 and 0.00).When HRV increased and parasympathetic nerve was excited in patients with valvular disease,Em/Am decreased(left atrial function and/or left ventricular diastolic functio

关 键 词：心率变异性 超声心动图 肺动脉收缩压 自主神经 

分 类 号：R542.5[医药卫生—心血管疾病]