摘要
目的 观察心率震荡（HRT）现象在慢性充血性心力衰竭（CHF）患者中的变化,并探讨其临床意义.方法 选择66例CHF患者和30例室性期前收缩者（对照组）.其中CHF患者按纽约心功能分级（NYHA）分为轻度CHF组（NYHA Ⅱ级,29例）和重度CHF组（NYHA Ⅲ～Ⅳ级,37例） 又根据预后不同分为死亡组（11例）和生存组（55例）.所有研究对象经超声心动图测最左心室射血分数（LVEF）和左心室舒张末期内径（LVEDD）,并行动态心电图（Holter）检查,获取震荡初始（TO）和震荡斜率（TS）.结果 CHF患者HRT现象明显减弱,CHF组TO和LVEDD明显大于对照组[1.65%±1.49%比-1.02%±0.76% （59.85±4.46）mm比（47.64±4.96）mm,均为P＜0.01],TS和LVEF明显小于对照组[（4.13±2.07）ms/RR比（7.86±3.02）ms/RR 53.34%±11.00%比69.46%±12.75%,均为P＜0.01].重度CHF组TO高于轻度CHF组,但差异无统计学意义.重度CHF组TS和LVEF则明显低于轻度CHF组[（3.22±1.52）ms/RR比（5.28±2.12）ms/RR 46.34%±6.88%比62.20%±8.59%,均为P＜0.01],LVEDD明显大于轻度CHF组[（59.53±4.91）mm比（55.27±3.91）mm,P＜0.01].死亡组TS和LVEF明显低于生存组[（1.92±0.79）ms/RR比（4.34±1.97）ms/RR,44.27%±7.50%比55.09%±10.75%,均为P＜0.01],LVEDD和TO明显大于生存组[（58.45±5.11）mill比（55.35±4.19）mm,2.75%±1.75%比1.43%±1.35%,均为P＜0.05].HRT 0级 生存组患者多于死亡组[8例（14.5%）比0（0）,P＞0.05],HRT 1级：生存组患者明显多于死亡组[39例（70.9%）比3例（27.3%）,P＜0.05],HRT 2级：生存组患者明显少于死亡组[8例（14.5%）比8例（72.7%）,P＜0.01].死亡与TO、HRT 2级和LVEDD呈正相关（均为P＜0.05）,与TS和LVEF呈负相关（P＜0.01）.结论 重度CHF患者心率震荡现象明显减弱,HRT可作为CHF患者危险性评估的指标.
Objective To observe the changes of the heart rate turbulence （HRT） in patients with congestive heart failure （CHF） and to explore the clinical significance. Methods The 66 patients with CHF and 30 subjects with premature ventricular contraction were enrolled in the study. The 66 CHF patients were classified into the mild group （ NYHA Ⅱ, n = 29 ） and the severe group （ NYHA Ⅲ-Ⅳ, n = 37 ） according to the NYHA classification criteria, and divided into the mortality group （n = 11 ） and the survival group （n = 55）. Left ventricular ejection fraction （LVEF） and left ventricular end diastolic diameter （LVEDD） of all the 96 subjects were measured by echocardiography. Then turbulence onset （TO） and turbulence slope （TS） were obtained from Holter analysis. Results HRT of the CHF patients was significantly weakened. The TO and LVEDD of the CHF patients were significantly increased than those of the control group [1.65% ±1.49% vs. -1.02% ±0.76%; （59.85±4.46） mmvs. （47.64±4.96） mm, bothP〈0.01], with the TS and LVEF significantly reduced [ （ 4. 13 ± 2. 07 ） ms/RR vs. （ 7. 86 ±3.02 ） ms/RR; 53.34% ±11.00% vs. 69.46%± 12. 75%, bothP 〈0.01 ]. The TO of the severe group were slightly higher than those of the mild group （P 〉 0. 05 ）, but with no statistical significance. The TS and LVEF of the severe group were significantly reduced than those in the mild group [ （3.22 ± 1.52） ms/RR vs. （5.28 ± 2. 12） ms/RR; 46. 34% ~ 6. 88% vs. 62. 20% ±8.59%, both P 〈 O. 01 ] and the LVEDD was significantly increased [ （59. 53 ~ 4. 91 ） mm vs. （55.27 ~ 3.91 ） ram, P 〈 0. 01 ]. The TS and LVEF of the mortality group were significantly reduced than those in the survival group [ （ 1.92±0. 79 ） ms/RR vs. （4. 34±1.97） ms/RR, 44. 27% ±7.50% vs. 55. 09% ± 10.75%, bothP〈0. 01], and the LVEDD and TO were significantly increased [ （58. 45 ±5. 11 ） mm vs. （55.35 ±4. 19） mm, 2. 75%± 1.75% vs. 1.43% ± 1.35% ,both P 〈 0.05]. M1 c
出处
《中国心血管杂志》
2010年第5期364-367,共4页
Chinese Journal of Cardiovascular Medicine
关键词
心率
心力衰竭
充血性
自主神经系统
危险性评估
Heart rate
Heart failure,congestive
Autonomic nervous system
Risk assessment
