摘要
对２５例重度充血性心力衰竭（ＣＨＦ）患者在地高辛治疗前后测定血浆去甲肾上腺素（ＮＥ）及心率变异（ＨＲＶ）。结果显示：ＮＥ基础值与ＨＲＶ时域指标基础水平均呈负相关（Ｐ＜０．０５或＜０．０１）。地高辛治疗前后的ＮＥ相比（２９１±８０ｐｇ／ｍｌｖｓ２１３±８２ｐｇ／ｍｌ），Ｐ＜０．００１。２４小时平均ＲＲ间期及２４小时正常ＲＲ间期标准差由治疗前的７２７±１２３ｍｓ及６７．７±２１．８ｍｓ分别增加至７７７±１２２ｍｓ及８７．２±２９．２ｍｓ（Ｐ均＜０．０５）；２４小时相邻ＲＲ间期差值的均方根（ＲＭＳＳＤ）、２４小时正常相邻ＲＲ间期之差大于５０ｍｓ的心搏数所占百分比（ＰＮＮ５０）及高频（ＨＦ）由治疗前的３６．３±３０．６ｍｓ、５．３±５．５％及３７．１±２１．２ｍｓ２分别增加至５６．１±４３．７ｍｓ、１０．８±１０．６％及７９．９±５８．２ｍｓ２（Ｐ值＜０．０５至＜０．０１）；低频（ＬＦ）由治疗前的１１８．９±１３３．２ｍｓ２增加至１７１．２±１７２．８ｍｓ２（Ｐ＜０．００５）；ＮＥ下降幅度与时域指标增加幅度均呈正相关。ＨＲＶ多数时域指标增加幅度及其绝对值与血清地高辛浓度呈正相关，以ＲＭＳＳＤ和ＰＮＮ５０尤为显著（Ｐ?
patients with severe congestive heart failure (CHF) were underwent digoxin therapy of one week to evaluate the relationship between autonomous nervous function and heart rate variability (HRV),and effect of digoxin on it.Plasma levels of norepinephrine (NE) and HRV were determined before and after digoxin therapy.The results showed that basic NE levels had significant negative correlation with all the time domain variables of HRV.Digoxin therapy improved cardiac function by a mean of 1.52±0.51 NYHA functional class;NE levels decreased significantly from a mean of 291±80 pg/ml to 213±82 pg/ml( P <0.001) with concomitant increase in variables of HRV.Among them,mean normal RR interval and SDNN increased significantly from 727±123 ms and 67.7±21.8 ms to 777±122 ms and 87.4±29.2 ms respectively;variables reflecting cardiac vagal activity such as RMSSD,PNN 50 and HF increased significantly from 36.3±30.6 ms,5.3±5.5% and 37.1±21.2 ms 2 to 56.1± 43.7 ms ,10.8±10.6% and 79.9±58.2 ms 2 respectively.A significant positive correlation was found between the changes in plasma NE levels and the changes in all the time domain variables of HRV after digoxin therapy;in addition,the changes in most of the time domain variables of HRV and their post treatment levels,especially variables reflecting cardiac vagal activity,eg,RMSSD and PNN 50 were strongly correlated with serum digoxin levels.It was concluded that the increased sympathetic nerve activity paralleled to decreased HRV in patients with severe CHF,Digoxin therapy could increase cardiac vagal tone and improve HRV and cardiac function in patients with severe CHF.
出处
《中国心脏起搏与心电生理杂志》
1997年第1期9-11,共3页
Chinese Journal of Cardiac Pacing and Electrophysiology
关键词
充血性
心力衰竭
自主神经系统
心率变异
地高辛
Heart failure
congestive Autonomous nervous system Heart rate variability Digoxin
