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目的:探讨冠心病患者心率变异性与心脏变时功能不全的关系。方法:选择经冠状动脉造影确诊的91例冠心病患者,冠状动脉造影前1个月内完成24h动态心电图检查并求心率变异时域指标,完成症状限制性踏车运动试验并求心脏变时功能指标最高心率与预测最大心率值之比(rHR)和心率储备率(HRR)。结果:变时功能不全患者各项心率变异指标显著低于变时功能正常者(P<0.01)。所有病例的心率变异指标SDNN、SDANN、SDNNindex、rMssD及PNN50与rHR(依次r=0.548、0.453、0.325、0.340、0.211)和HRR(依次r=0.580、0.477、0.363、0.338、0.190)均存在明显正相关(均P<0.01)。结论:冠心病患者心脏变时功能不全与心脏自主神经功能失常密切相关,其可能的机制与运动中迷走神经活性抑制不全和交感神经活性增强受限有关。
Objective: To investigate the relationship between heart rate variability and cardiac dysfunction in patients with coronary heart disease. Methods: Ninety-one CHD patients diagnosed by coronary angiography were selected. Within 24 hours after coronary angiography, Holter ECG examination was completed and time-domain index of heart rate variability was calculated. The symptom-limited treadmill exercise test was completed and the function of cardiac variability Indicator maximum heart rate and predicted maximum heart rate value (rHR) and heart rate reserve rate (HRR). Results: The indexes of heart rate variability in patients with variable dysfunction were significantly lower than those in patients with normal change of function (P <0.01). The heart rate variability indexes SDNN, SDANN, SDNNindex, rMssD, PNN50 and rHR (r = 0.548,0.453,0.325,0.340,0.211) and HRR (r = 0.580,0.477,0.363,0.338,0.190) in all cases were significant Positive correlation (all P <0.01). CONCLUSION: In patients with coronary heart disease, chronotropic dysfunction is closely related to dysfunction of cardiac autonomic nerve. The possible mechanism is related to the inhibition of vagus nerve activity and restricted sympathetic nerve activity during exercise.