老年陈旧性脑梗死患者心率变异性及其干预与心脑血管并发症的影响研究  

Relationship between Heart Rate Variability and the Effect of Intervention and Cardio-Cerebrovascular Complications in Elderly Patients with Old Cerebral Infarction

作　　者：赵佳 陈瞳[2] 耿凡琪 王燕[2] 张利方[2] 韩迪[2] 

机构地区：[1]青岛大学医学部,山东 青岛 [2]青岛大学附属医院全科医学科,山东 青岛

出　　处：《临床医学进展》2023年第7期11423-11432,共10页Advances in Clinical Medicine

摘　　要：目的:探讨老年陈旧性脑梗死患者心率变异性(HRV)及其干预对心脑血管并发症的关系。方法:回顾性筛选2018年1月至2022年1月于青岛大学附属医院住院的老年陈旧性脑梗死患者239例;根据出院是否长期接受β受体阻滞剂治疗分为特殊治疗组103例,常规治疗组136例,比较两组用药1年后的HRV各指标及心脑血管并发症的差异,采用Kaplan-Meier法绘制不同治疗方案陈旧性脑梗死患者的生存曲线,采用Cox比例风险回归分析探究陈旧性脑梗死患者心脑血管并发症的影响。结果:特殊治疗组患者治疗前后比较显示,时域指标HRV时域参数R-R间期标准差(SDNN)、RR间期标准差的平均值(SDNN index)、相邻RR间期差值的均方根(RMSSD)及频域指标高频功率HF均升高(P 50 ms心搏数占总心搏次数的百分比(pNN50)、及频域指标HF均升高(P < 0.05),频域指标(LF/HF)降低(P < 0.05);特殊治疗组心脑血管并发症总发生率较常规治疗组降低(P < 0.05)。在老年陈旧性脑梗死患者中,特殊治疗组OS优于常规治疗组患者(χ2 = 5.509, P = 0.019)。多因素Cox回归分析显示,SDNN、SDANN、PNN50、是否给予β受体阻滞剂治疗是老年陈旧性脑梗死患者心脑血管并发症的影响因素(P < 0.05)。结论:陈旧性脑梗死患者仍存在HRV降低,自主神经功能障碍,给予陈旧性脑梗死患者调节自主神经功能的药物,仍可预防心脑血管不良事件,改善卒中预后。其中,SDNN、SDANN、PNN50是老年陈旧性脑梗死患者发生心脑血管并发症的独立影响因素。Objective: To investigate the relationship between heart rate variability (HRV) and cardio-cere- brovascular complications in elderly patients with old cerebral infarction (SPCI). Methods: A total of 239 elderly patients with old cerebral infarction who were hospitalized in Affiliated Hospital of Qingdao University from January 2018 to January 2022 were retrospectively selected. All patients were divided into 2 groups, the special treatment group (n = 103) and the traditional treatment group (n = 136), according to whether they received special treatment after discharge. The differ-ences of cardio-cerebrovascular complications after one year were compared between the two groups. Kaplan-Meier method was used to draw the survival curve of patients with old cerebral in-farction. Under different treatment schemes, Cox proportional risk regression analysis was used to explore the influence of cardio-cerebrovascular complications in patients with old cerebral infarc-tion. Results: The comparison before and after treatment in the special treatment group showed that the HRV time-domain SDNN, SDNN index, RMSSD and HF were all increased (P < 0.05), while LF/HF in the frequency domain was decreased (P < 0.05). After treatment, compared with the spe-cial treatment group and the traditional treatment group showed that HRV time-domain index SDNN, SDANN, SDNN index, PNN50 and frequency domain index HF were all increased (P < 0.05), the frequency domain index (LF/HF) was decreased (P < 0.05). The total incidence of cardio-cere- brovascular complications in the special treatment group was lower than that in the traditional treatment group (P < 0.05). In the elderly patients with old cerebral infarction, the OS in the special treatment group was better than that in the traditional treatment group (χ2 = 5.509, P = 0.019). Multivariate Cox regression analysis showed that SDNN, SDANN, PNN50 and β-blocker therapy were influencing factors of cardio-cerebrovascular complications in elderly patients with old cerebral in-farction (P < 0

关 键 词：脑梗死 心率 自主神经系统 心脑血管并发症 

分 类 号：R54[医药卫生—心血管疾病]