急性重症脑卒中早期心率变异的研究  

Study on early heart rate variability in patients with severe acute cerebralvas cular disease

作　　者：李淑娟[1] 宿英英[1] 刘淼[1] 

机构地区：[1]首都医科大学宣武医院神经内科重症监护治疗病房,北京100053

出　　处：《中国危重病急救医学》2003年第9期546-549,共4页Chinese Critical Care Medicine

基　　金：北京市科委科研基金资助项目 ( 95330 4 0 0 3)

摘　　要：目的 :研究急性重症脑卒中早期心率变异 (HRV)的变化及其临床意义 ,建立 HRV对脑功能损伤的评价标准。方法 :大脑半球部位脑卒中患者 3 5例 ,根据格拉斯哥昏迷评分 (GCS)分为急性重症组 (GCS≤ 8分17例 )和非重症组 (GCS>8分 18例 )。所有患者发病 5 d内进行 Holter连续监测。结果 :1重症组与非重症组相比 HRV明显降低 ,以反映植物神经总活性和副交感神经活性的指标突出。 2动态监测发现正常 RR间期标准差 (SDNN)≤ 60 ms、总频谱 (TF)≤ 15 0 0 ms2 / Hz、高频谱 (HF)≤ 60 0 ms2 / Hz、低频谱 (L F)≤ 10 0 0 ms2 / Hz是预测预后的界限值 ;上述指标低于界限值提示病情恶化 ,预后不良 ;高于界限值则预示病情向好的方向发展 ,预后良好 ,其动态变化早于传统的 GCS。 3多因素 L ogistic回归分析显示仅 TF、HF和 GCS3个变量的 P值具有显著性差异 ,预后良好的预测准确率为 82 .14 % ,预后不良的预测准确率为 88.89%。结论 :重症脑卒中患者反映植物神经总活性和副交感神经活性的 HRV指标明显降低 ,HRV是预测急性重症脑卒中预后的一个独立、敏感、定量的指标。动态监测 HRV可判断脑功能损伤程度 ,了解病情演变趋势 。Objective: To investigate the dynamic changes of heart rate variabi lity (HRV) in acute cerebral vascular disease, in order to make a criteria for e valuatin g cerebral function, and establish an assessment for risk stratification after a cute stroke. Methods: All 35 patients who suffered from cerebral vascular disease in t he distribution of the carotid artery system were studied from 1 to 7 days foll owing the stroke. HRV analysis with 24hour Holter tapes were perform ed every day or every other day continuously for 5 days. According to GCS, the p atients were divided into two groups. Critical cerebral vascular disease(CCVD): a state of s evere cerebral dysfunction with the Glasgow coma scale(GCS) value between 3 and 8. Noncritical cerebral vascular disease(nCCVD): a state of slightly cerebral dysfunction with the GCS value between 9 and 15. Results: Of the 35 patients,17 were classified to CCVD, 18 to nCCVD. The CCVD patients ha d significantly decreased HRV, especially the standard deviation of all RR intervals(SDNN) and total frequency(TF). The 24hour heart ra te variabil ity graph lost its circadian variation showing a low and plain curve during the whole day. There was a significant correlation between the decrease of HRV and b ad prognosis. The borderline of HRV for prognosis was: SDNN≤60 ms、 TF≤1 500 ms 2/Hz, high frequency(HF)≤600 ms 2/Hz, low freq uency(LF)≤1000 ms 2/Hz. Dynamic observation proved that if the components of HRV reached this standard, it always indicated bad outcome. On the contrary, if those components increased continuously and were higher than those of the above, it was always indicative of good outcome. These changes always advanced GCS. Prognosis had a high correlate with TF, LF, HF and GCS. Logistic regression showed that only TF, HF and GCS were the main factors affecting the prognosis. The accurate rate of death predication was 88 89 percent, the accurate rate of survival was 82 14 percent. It was much better than the traditional GCS. Conc

关 键 词：脑卒中 心率变异 脑功能 植物神经 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R331.31[医药卫生—临床医学]