心肌缺血患者心率减速力、连续心率减速力、心率变异性表现及其相关性

doi:10.3969/j.issn.1004-583X.2021.12.005

摘要/Abstract

摘要：

目的探讨心肌缺血患者心率减速力(DC)、连续心率减速力(DRs)、心率变异性(HRV)表现及其相关性,为心肌缺血诊断提供参考。方法选取2019年10月至2020年8月我院收治的冠心病慢性心肌缺血综合征患者86例,其中无症状心肌缺血(SMI)患者59例为A组,有心绞痛等症状患者27例为B组,选取同期在我院检测的疑似心肌缺血的健康成年人60例为对照组,各组均行24 h动态心电图监测,对比各组DC、DRs、HRV表现及其相关性。结果 A组、B组DC、DR4、DR8值低于对照组(均 P<0.05),A组、B组SDNN、SDANN、RMSSD、pNN50值均低于对照组(均 P<0.05),A组上述指标略低于B组,但差异无统计学意义(均 P>0.05);86例心肌缺血患者DC、DR2、DR4、DR8值与SDNN、SDANN、RMSSD、pNN50值存在显著正相关(均 P<0.05)。结论心肌缺血患者DC、DRs、HRV水平比健康人群明显降低,且DC、DRs值与HRV值存在正相关,可为心肌缺血临床检查提供参考。

关键词: 心肌缺血, 心率减速力, 动态心电图, 心率变异性

Abstract:

Objective To investigate the manifestation and correlation of heart rate deceleration capacity(DC), heart rate deceleration runs(DRs) and heart rate variability(HRV) in patients with myocardial ischemia(MI), in order to provide reference for MI. Methods From october 2019 to August 2020, totally 86 patients with chronic MI were enrolled, of which 59 inpatients with asymptomatic myocardial ischemia(SMI) were regarded as treatment group A, 27 patients with angina pectoris(AP) as treatment group B, 60 healthy adults suspected MI admitted to our hospital were comprised control group, 24h dynamic electrocardiogram(DCG) were monitored, the correlation of DC, Drs and HRV were compared in groups. Results DC, DRs (DR4, DR8) were lower in two treatment groups than in control group (all P<0.05); standard deviation(SD) of all normal to normal(NN) intervals(SDNN), standard deviation of the 5-min average of N-N intervals(SDANN), square root of the mean squared difference of successive RR intervals(RMSSD), percetange of adjacent NN intervals differing by more than 50 milliseconds (pNN50) were lower in two treatment groups than in control group (all P<0.05) ; The above indexes were slightly lower in treatment group A than in treatment group B, but the differences were not statistically significant (all P>0.05). A significant positive correlation were found between DC, DR2, DR4, DR8 and SDNN, SDANN, RMSSD, pNN50 in MI patients (all P<0.05). Conclusion The levels of DC, DRs, HRV in MI patients are lower in comparison with healthy people; and DC, DRs are significantly positively correlated with HRV. DC, DRs, HRV can provide reference for clinical examination of MI.

Key words: myocardial ischemia, heart rate deceleration capacity, dynamic electrocardiogram, heart rate variability

中图分类号:

R542.2

于丹. 心肌缺血患者心率减速力、连续心率减速力、心率变异性表现及其相关性[J]. 临床荟萃, 2021, 36(12): 1083-1086.

Yu Dan. Manifestation and correlation of deceleration capacity and heart rate deceleration runs and heart rate variability of myocardial ischemia in patient[J]. Clinical Focus, 2021, 36(12): 1083-1086.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.12.005

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I12/1083

图/表 4

表1 3组一般资料比较

组别	例数	性别[例(%)]		年龄 (岁)	BMI (kg/m²)	吸烟史 [例(%)]	饮酒史 [例(%)]	收缩压 (mmHg)	舒张压 (mmHg)	ECG基础心率 (次/min)
组别	例数	男	女	年龄 (岁)	BMI (kg/m²)	吸烟史 [例(%)]	饮酒史 [例(%)]	收缩压 (mmHg)	舒张压 (mmHg)	ECG基础心率 (次/min)
A组	59	38(64.41)	21(35.59)	62.64±6.90	24.65±3.14	38(64.40)	26(44.07)	128.13±13.12	82.92±11.37	79.46±23.47
B组	27	17(62.96)	10(37.04)	59.30±6.38	24.23±2.38	17(62.96)	12(44.44)	126.72±14.24	82.48±9.27	76.83±21.35
对照组	60	37(61.67)	23(38.33)	61.83±7.11	23.89±2.67	36(60.00)	24(40.00)	123.84±12.48	79.68±8.24	75.89±19.27
$F$ /χ²值		0.849		1.373	1.139	0.976	0.824	1.432	1.235	1.594
$P$ 值		0.538		0.589	0.678	0.594	0.542	0.427	0.618	0.253

表1 3组一般资料比较

组别	例数	性别[例(%)]		年龄 (岁)	BMI (kg/m²)	吸烟史 [例(%)]	饮酒史 [例(%)]	收缩压 (mmHg)	舒张压 (mmHg)	ECG基础心率 (次/min)
组别	例数	男	女	年龄 (岁)	BMI (kg/m²)	吸烟史 [例(%)]	饮酒史 [例(%)]	收缩压 (mmHg)	舒张压 (mmHg)	ECG基础心率 (次/min)
A组	59	38(64.41)	21(35.59)	62.64±6.90	24.65±3.14	38(64.40)	26(44.07)	128.13±13.12	82.92±11.37	79.46±23.47
B组	27	17(62.96)	10(37.04)	59.30±6.38	24.23±2.38	17(62.96)	12(44.44)	126.72±14.24	82.48±9.27	76.83±21.35
对照组	60	37(61.67)	23(38.33)	61.83±7.11	23.89±2.67	36(60.00)	24(40.00)	123.84±12.48	79.68±8.24	75.89±19.27
$F$ /χ²值		0.849		1.373	1.139	0.976	0.824	1.432	1.235	1.594
$P$ 值		0.538		0.589	0.678	0.594	0.542	0.427	0.618	0.253

表2 3组DC值与DRs值比较($\bar{x}\pm s$)

组别	例数	DC(ms)	DRs
组别	例数	DC(ms)	DR2(%)	DR4(%)	DR8(%)
A组	59	3.54±1.27^*	5.38±1.41	0.35±0.26^*	0.006±0.002^*
B组	27	4.05±1.42^*	5.74±1.24	0.43±0.25^*	0.009±0.001^*
对照组	60	6.15±1.36	5.96±1.55	0.69±0.28	0.028±0.006
F值		14.272	0.832	9.274	6.939
P值		<0.01	0.452	<0.01	0.004

表3 3组HRV值比较($\bar{x}\pm s$)

组别	例数	SDNN(ms)	SDANN(ms)	RMSSD(ms)	pNN50(%)
A组	59	105.53±25.64^*	104.83±26.22^*	25.14±6.34^*	8.23±8.31^*
B组	27	107.65±23.69^*	106.35±28.64^*	26.93±7.27^*	8.92±7.26^*
对照组	60	134.24±27.76	132.57±29.63	49.52±23.77	14.82±8.75
F值		8.247	9.372	17.582	15.274
P值		<0.01	<0.01	<0.01	<0.01

表4 DC、DRs值与HRV值的相关分析

项目	DC(ms)		DRs
	DC(ms)		DR2(%)		DR4(%)		DR8(%)
	r值	P值	r值	P值	r值	P值	r值	P值
SDNN	0.224	<0.05	0.196	<0.05	0.223	<0.05	0.245	<0.05
SDANN	0.213	<0.05	0.188	<0.05	0.196	<0.05	0.212	<0.05
RMSSD	0.256	<0.05	0.205	<0.05	0.246	<0.05	0.237	<0.05
pNN50	0.202	<0.05	0.194	<0.05	0.191	<0.05	0.258	<0.05

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