某部官兵无症状性心律失常的筛查与干预对策

Screening and intervention methods for asymptomatic arrhythmia in officers and soldiers of a certain army

目的探究某部官兵无症状性心律失常的筛查与干预对策。方法收集某部2019-12至2021-12无症状性心律失常官兵80例作为观察组,另选取50例体检、听诊心律规则的官兵作为对照组。对80例无症状心律失常患者的类型构成进行分析,对比两组心率变异性(HRV)指标,即相邻正常R-R间期差值>50 ms的%(PNN50)、24 h正常R-R间期的标准差(SDNN)、每5 min的平均NN间期的标准差(SDANN)、相邻正常R-R间期差值的均方根(RMSSD)、NN间期的个数除以NN期间直方图的高度(HRV三角指数)及动态血压[总体平均收缩压(mSBP)、总体平均舒张压(mDBP)、白天平均收缩压(dSBP)、白天平均舒张压(dDBP)、夜间平均收缩压(nSBP)、夜间平均舒张压(nDBP)]的差异,观察两组超声检查结果。结果(1)80例中良性室性期前收缩占比最高,为61.25%(49/80);(2)观察组PNN50(3.29%±1.50%)、SDNN[(160.02±43.38)ms]、SDANN[(146.58±41.10)ms]、RMSSD[(33.65±13.34)ms]、HRV三角指数(45.77±13.36)水平均明显低于对照组[(11.05%±5.39%),(247.21±51.35)ms,(238.50±59.78)ms,(61.10±20.17)ms,57.94±15.32],差异有统计学意义(P<0.05);(3)观察组mSBP[(117.35±8.94)mmHg]、mDBP[(67.47±5.38)mmHg]、dSBP[(125.98±10.35)mmHg]、dDBP[(74.33±8.25)mmHg]、nDBP[(62.45±4.84)mmHg]水平均显著高于对照组[(112.32±7.89),(64.31±4.29),(121.05±7.99),(70.78±5.90),(59.32±3.65)mmHg],差异有统计学意义(P<0.05);(4)心脏超声心动图检测结果均未发现心房及心室增大、肺动脉高压。结论部队官兵的无症状性心律失常表现为心率变异性的降低与动态血压的升高,应及时采取针对性的防治措施。

Objective To explore the screening and intervention methods of asymptomatic arrhythmia in officers and soldiers of a certain army.Methods The data of 80 officers and soldiers with asymptomatic arrhythmia in a certain army from December 2019 to December 2021 were collected,and 50 officers and soldiers with physical examination and auscultation rules were selected as the control group;Analysis and comparison of heart rate variability(HRV)indicators was made,such as the percent of the difference between adjacent normal RR intervals>50 ms(pNN50),24 h normal RR interval standard deviation(SDNN),average NN per 5 min The standard deviation of the interval(SDANN),the root mean square of the difference between adjacent normal RR intervals(RMSSD),the number of NN intervals divided by the height of the histogram during the NN period(HRV triangle index)and the overall differences of ambulatory blood pressures[mean systolic blood pressure(mSBP),overall mean diastolic blood pressure(mDBP),mean daytime mean systolic blood pressure(dSBP),mean daytime mean diastolic blood pressure(dDBP),mean nighttime mean systolic blood pressure(nSBP),and mean nighttime mean diastolic blood pressure(nDBP)].The results of ultrasonography in the two groups were observed.Results Among the 80 patients with asymptomatic arrhythmia,benign premature ventricular contractions accounted for the highest proportion,61.25%(49/80);PNN50(3.29%±1.50%),SDNN[(160.02±43.38)ms],SDANN[(146.58±41.10)ms],RMSSD[(33.65±13.34)ms],HRV triangular index(45.77±13.36)in the observation group were significantly lower than those in the control group[(11.05%±5.39%),(247.21±51.35)ms,(238.50±59.78)ms,(61.10±20.17)ms,57.94±15.32],P<0.05;the levels of mSBP[(117.35±8.94)mmHg],mDBP[(67.47±5.38)mmHg],dSBP[(125.98±10.35)mmHg],dDBP[(74.33±8.25)mmHg]and nDBP[(62.45±4.84)mmHg]in the observation group were significantly higher than those in the control group[(112.32±7.89),(64.31±4.29),(121.05±7.99),(70.78±5.90),(59.32±3.65)mmHg],P<0.05;the echocardiography results of all officers and soldiers showed that no atrial and ventricular enlargement and pulmonary hypertension were found.Conclusion The asymptomatic arrhythmia of soldiers in the army is manifested as a decrease in heart rate variability and an increase in ambulatory blood pressure,and targeted preventive measures should be taken in time.