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目的 了解煤工尘肺(CWP)患者心率变异(HRV)的临床变化。方法 观察100 例Ⅰ、Ⅱ、Ⅲ期CWP患者和30例健康煤矿工人在临床、动态心电图(DCG)和HRV的改变。结果 (1)Ⅰ、Ⅱ、Ⅲ期CWP患者的心率变异指数(HRVI)分别为26.06±10.89、22.27±8.12、16.88±4.15,平均R R间期标准差(S)分别为(38.86±18.43、31.96±16.45、25.44±18.21)s,平均R R间期变异系数(CV)分别为4.55±1.82、3.84±1.50、2.99±1.23,较对照组(30.06±10.88、50.08±25.25、6.46±2.65)明显降低,差异有统计学意义(P<0.05),Ⅲ期CWP各指标比Ⅰ期降低明显,差异有统计学意义(P<0.01)。(2)严重室性心律失常组的HRVI、S、CV分别为15.88±4.14、(20.32±9.52)s、2.52±0.88,较轻级室性心律失常组[24.16±8.12、(30.87±17.44)s、3.26±1.64]及对照组[30.06±10.88、(50.08±25.25)s、6.46±2.65]降低,差异有统计学意义(P<0.05),提示CWP患者的交感神经张力亢进,迷走神经张力减弱,易发生严重室性心律失常。结论 CWP患者的HRV指标明显降低,可预测CWP患者严重室性心律失常或心性猝死的发生。
Objective To understand the clinical changes of heart rate variability (HRV) in coal worker’s pneumoconiosis (CWP) patients. Methods The changes of clinical, ambulatory electrocardiogram (DCG) and HRV were observed in 100 patients with stage Ⅰ, Ⅱ and Ⅲ CWP and 30 healthy coal miners. Results (1) HRVI of Ⅰ, Ⅱ and Ⅲ CWP patients were 26.06 ± 10.89,22.27 ± 8.12 and 16.88 ± 4.15 respectively, and the mean standard deviation (S) of RR interval were (38.86 ± 18.43 and 31.96 ± 16.45,25.44 ± 18.21) s, the average RR interval variation coefficient (CV) were 4.55 ± 1.82, 3.84 ± 1.50 and 2.99 ± 1.23, respectively, which were significantly lower than those in the control group (30.06 ± 10.88, 50.08 ± 25.25 and 6.46 ± 2.65) , The difference was statistically significant (P <0.05). The index of stage Ⅲ CWP was significantly lower than that of stage Ⅰ, the difference was statistically significant (P <0.01). (2) The HRVI, S and CV of severe ventricular arrhythmia group were 15.88 ± 4.14, (20.32 ± 9.52) s and 2.52 ± 0.88, respectively. Compared with those of mild ventricular arrhythmia group [24.16 ± 8.12 (30.87 ± 17.44) s, 3.26 ± 1.64, and 30.06 ± 10.88, (50.08 ± 25.25) s, 6.46 ± 2.65, respectively), showing significant difference (P <0.05), suggesting that sympathetic tone and vagal tone weaken in CWP patients , Prone to severe ventricular arrhythmias. Conclusion The HRV index of CWP patients is significantly lower than that of CWP patients, which can predict serious ventricular arrhythmia or sudden cardiac death in CWP patients.