急性脑缺血应激性脑-心综合征临床研究

A Clinic Investigation on Irritated Cerebro-cardiac Syndrome Following Acute Cerebral Ischemia

目的 :观察急性脑梗塞患者心电图 (ECG)、心脏自主神经活性变化 ,探讨脑 心综合征发生的中枢机制。方法 :利用标准 12导联动态心电图技术记录 86例急性脑梗塞患者和 4 3例正常对照的心电信号 ,分析比较不同部位半球梗塞患者心率变异性变化。结果 :1 急性脑梗塞患者出现快速心率失常、QT间期延长和S T段下移 ;2 脑梗塞组的相邻心搏间期差大于 10ms的间期数占RR间期总数的百分比、均方根值 (squarerootofthemeansquareddifferencesofsuccessiveNNintervals ,RMSSD)、总频、高频、混沌参数是降低的 ,而低频 /高频相对增高 ,与正常对照组比较差异有显著性 (P <0 0 1) ,以右侧岛叶较其他部位梗塞变化明显 (P <0 0 5 )。结论 :急性脑梗塞出现心电图异常、自主神经活性变化等脑 心综合征表现 ,故对脑梗塞患者必须加强ECG及心脏自主神经活性的监测 ,以防脑源性不良反应发生。

Objective: To investigate the role of central nervous system in the genesis of cerebrocardiac syndrome through observation on the changes of ECG and autonomic cardiovascular disturbances in acute cerebral ischemia. Methods: ECG, heart rate variability (HRV) of 86 patients with acute cerebral ischemia and 43 normal control subjects were analyzed with short term electrocardiographic recording. Variable changes of heart rates in patients with hemisphere infarction of different area were analyzed. Results: 1) Supraventricular arrhythmias, prolonged QTc and ST segment downward deviation were found in patients with acute cerebral ischemia. 2) Some measured components of HRV, i.e. square root of the mean squared differences of successive NN intervals (RMSSD), percentages of NN interval differences under 10 (PNN10), total power (TP), low frequency power (LF), high frequency power (HF), fractal dimension (FD) were significantly lower, while LF/HF was significantly higher in patients with acute cerebral ischemia compared with control groups. There was significant difference in effective rate (P<0.01). Changes in patients with right insular ischemia were more obvious than in patient with lesion in other regions (P<0.05). Conclusions: Since diturbances of ECG and autonomic cardiovascular activation can be observed during the process of cerebrocardiac syndrome after acute cerebral ischemia, and observations of ECG and autonomic cardiovascular disturbances in patients with acute cerebral ischemia should be strengthened to prevent cerebrogenic harmful reaction.