摘要
目的比较不同部位老年脑梗死患者各项心率变异性（HRV）指标的差异，分析美国国立卫生院神经功能缺损评分（NIHSS）与上述各项心率变异性指标的相关性。方法筛选首次患急性半球梗死的患者45例（半球梗死组），急性脑干梗死患者40例（脑干梗死组）及无卒中病史的健康体检者40例（对照组），详细记录患者的基本信息及常规危险因素，急性脑梗死患者行NIHSS评分，所有患者行24h动态心电图检查，比较3组HRV各参数的差异，采用Spearman相关分析脑梗死患者HRV各参数与NIHSS评分的相关性。结果半球梗死组及脑干梗死组的HRV时域参数R—R间期（NND、R-R间期标准差（SDNN）、差值均方根（RMSSD）及相邻RR间期差〉50IT／S的个数占总心跳次数的百分比（PNN50）、频域参数R-R间期低频功率（LF）、R—R间期高频功率（HF）与对照组比较均显著降低（P〈0．05），半球梗死组频域参数交感／迷走平衡指数（LF／HF）明显升高（P〈0．05）。半球梗死组HF低于脑干梗死组（P〈0．05），LF／HF高于脑干梗死组（P〈0．05）。对半球左、右两侧梗死进行比较，右侧半球梗死组RMSSD、PNN50、HF低于左侧半球梗死组，LF／HF高于左侧半球梗死组（均P〈0．05）。Spearman相关分析显示NIHSS评分与RMSSD（r=-0．385，P=0．003）、PNN50（r=-0．372，P=0．008）及HF（r=-0．583，P=0．000）呈线性负相关，与LF／HF（r=0．427，P=0．002）呈线性正相关。结论不同部位脑梗死均造成心脏自主神经功能受损，右侧大脑半球梗死患者受损最严重；NIHSS评分与心脏自主神经损害程度相关，高NIHSS评分患者应加强心脏监护。
Objective To study the difference in heart rate variability in aged patients with different cerebral infarction localization and its correlation with the National Institutes of Health Stroke Scale（NIHSS） scores. Methods Totally 45 patients with acute hemisphere infarction （hemisphere infarction group）, 40 patients with acute brainstem infarction （brainstem infarction group）and 40 healthy subjects with no history of stroke（control group）were enrolled. All the patients completed the registration of basic information and general risk factors. NIHSS scores of acute cerebral infarction patients were evaluated. 24h Holter electrocardiogram of all the subjects were monitored. The differences in HRV parameters were compared among the three groups, and spearman correlation analysis was used for analysis of the correlation between HRV parameters and NIHSS scores. Results Both hemisphere infarction group and brainstem infarction group showed that normal-to-normal beat interval（NNI）, standard deviation of normal-to-normal intervals （SDNN）, square root of the mean squared successive differences between normal-to-normal RR intervals（RMSSD）,percentage of adjacent normal-to-normal intervals that differed more than 50 ms（PNNS0）, low-frequency power （LF）and high-frequency power（HF）were all significantly reduced as compared with those in the control group（ each P〈0.05 ）. While, sympathetic vagal balance index （LF/HF） were significantly increased in the hemisphere infarction group versus brainstem infarction group （P〈 0.05）. The HF was lower and the LF/HF was higher in hemisphere infarction group than in the brainstem infarction group（each P〈0.05）.RMSSD, PNN50 and HF were lower and LF/HF was higher in right hemisphere infarction group than in left hemisphere infarction group （ each P〈0.05 ） . Spearman correlation analysis showed that NIHSS score was negatively correlated with RMSSD（r=-0. 385, P = 0. 003）, PNN50 （ r = -0. 372, P = 0. 008 ）, and HF （ r =-0.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2016年第11期1155-1159,共5页
Chinese Journal of Geriatrics
基金
滨海新区卫生局医药卫生科技项目（2013BWKY025）
天津市卫生局科技基金（2013KZ021）
关键词
脑梗死
心率变异性
损伤严重度评分
心脏
自主神经系统
Brain infarction
Heart rate variability
Injury severity score
Heart
Autonomic nervous system
