103例沿海居民脑梗死患者不同局部定位对心脏自主神经功能的影响

Clinical study on the differential effects of ischemic stroke localization on autonomic function in 103 inhabitants living near the coast

目的 观察脑梗死患者不同局部定位对反映心脏自主神经功能的心率变异性 (heart ratevariability,HRV)各测值的影响。方法 对经 CT和 MRI证实的 10 3例脑梗死患者和 6 8例健康对照组HRV各测值进行分析。结果 (1)脑梗死组的 HRV各参数与对照组比较均显著降低 (P<0 .0 5 )。 (2 )半球梗死组中 ,右侧半球组各参数在半球中最低。 (3)脑干梗死组中 ,延髓各指标均低于对照组 ,SDNN、RMSSD、PNN50 降低显著 ;桥脑和中脑的 SDANN、SDNNindex显著降低。结论 脑梗死患者局部定位对心脏自主神经功能具有不同的影响。右侧半球及脑干 (尤其延髓 )梗死患者的 HRV下降对预测心血管事件有着十分重要的价值。

Objective To observe the differential effects of ischemic stroke localization on autonomic function parameters assessed by heart rate variability. Methods To determine the differential effects of ischemic stroke localization on autonomic cardiac innervation, an evaluation was made on the measured data from 103 patients with ischemic stroke and 68 people as controls. HRV analysis was performed and localization of infarction was determined by CT and MRI. Results (1)The various data in the schemic stroke group decreased significantly, when compared with those of the control group ( P < 0.05 ). (2) In the hemisphere infarction group, HRV data was the lowest in patients with right hemisphere lesion. (3) In the brainstem infarction group, various data of the medulla oblongata group were all lower than those of the control group; SDNN、RMSSD, PNN 50 in medullary infarction cases decreased significantly, when compared with those of the pontine and mesencephalic lesion groups. SDANN and SDNN index decreased significantly in the pontine and mesencephalic infarction groups. Conclusions The localization of ischemic stroke may have differential effects on autonomic function. Decrease of HRV in patients with right hemisphere infarction and brainstem infarction (especially the medulla oblongata) is of great importance in predicting cardiac events.