慢性心力衰竭患者动态心率震荡检测的临床意义.docVIP

慢性心力衰竭患者动态心率震荡检测的临床意义 　　作者：王兴德，李 剑，蒋兆华，杨光敏，谷守明，韩晓勤 作者单位：200125 上海，上海市浦南医院心功能室 　　【摘要】 目的 观察心率震荡的新指标mdash;动态心率震荡在慢性心力衰竭患者的变化及临床意义。方法 62例慢性心衰患者(心衰组)和35例非器质性心脏病患者(对照组)均接受24h Holter检查,分别计算HRT的震荡初始(TO)、震荡斜率(TS)、动态心率震荡(TD)及心率变异性的SDNN、SADNN、rMSSD值，并进行相关性分析。结果 心衰组TO明显高于对照组(0.62±3.20与-1.82±2.38,P0.01)，TS低于对照组(2.86±1.13与10.54±4.27,P0.001),TD低于对照组(0.056±0.038与0.15±0.062,P0.001);心衰组TO与SDNN、SADNN、rMSSD的相关系数分别为0.483、0.460、0.428(P均0.01)，TS与SDNN、SADNN、rMSSD的相关系数分别为-0.712、-0.679、-0.564,TD与SDNN、SADNN、rMSSD的相关系数分别为-0.796、-0.696、-0.599(P均0.001)。结论 慢性心衰患者中窦性心率震荡现象明显减弱,TO与SDNN、SADNN、rMSSD值呈正相关，TS和TD与SDNN、SADNN、rMSSD值呈负相关，TD的相关性强于TS。 　　【关键词】 动态心率震荡;心力衰竭;室性早搏;心率变异性 　　[Abstract] Objective To explore the change of turbulence dynamics (TD) in patients with chronic heart failure(CHF) and its clinical significance.Methods The HRT and HRV were measured in 62 CHF patients and 35 patients without obvious heart disease(control group). Turbulence onset(TO)，turbulence slope(TS)，Turbulence dynamics(TD) and SDNN，SADNN，rMSSD were measured by the original definitions using digitized Holter recordings.Results The value of the TO was significantly higher in CHF group than in control group[(0.62±3.20)% vs (-1.82±2.38)%，P0.01)]，The value of the TS and TD was significantly lower in CHF group than in control group(2.86±1.13 vs 10.54±4.27), (0.056±0.038 vs 0.15±0.062,P0.001 respectively); In CHF group, the correlation coefficint between TO and SDNN,SADNN,rMSSD was 0.483,0.460,0.428 respectively(P0.01,respectively), the correlation coefficient between TS and SDNN,SADNN,rMSSD was -0.712,-0.679,-0.564 respectively(P0.001,respectively), the correlation coefficient between TD and SDNN,SADNN,rMSSD was -0.796,-0.696,-0.599 respectively(P0.001,respectively).Conclusion HRT was significantly blunted in CHF patients .There was positive correlation between TO and SDNN,SADNN,rMSSD and negative correlation between TS,TD and SDNN,SADNN,rMSSD. 　　[Key words] turbulence dynamics; heart failure; ventricular premat