重度充血性心力衰竭患者心率和每搏输出量的凌晨分离现象研究

The divergence phenomenon of heart rate and stroke volume before dawn in serious heart failure

目的研究重度充血性心力衰竭患者血流动力学的昼夜节律改变。方法选择2005年12月至2006年6月在南京中医药大学无锡附属医院心内科住院的重度充血性心力衰竭患者120例为心衰组,同期门诊体检的无心血管疾病者20名为对照组,采用生物阻抗法每小时1次动态监测心率(HR)和每搏输出量(SV)。结果心衰组与对照组HR、SV均存在昼夜节律,但分布规律存在差异,心衰组HR明显快于对照组(P<0.5),而SV明显低于对照组(P<0.05);对照组HR与SV呈正相关(P<0.01),而心衰组HR与SV总体上也呈正相关(P<0.01),但在凌晨1:00～4:00之间,两组HR与SV分布曲线明显不同,心衰组HR与SV分布曲线出现分离现象,HR下降而SV上升,呈负相关(P<0.01),而同时段的对照组HR与SV则仍呈正相关(P<0.01)。结论重度充血性心力衰竭患者HR和SV分布的昼夜节律受损,在凌晨1:00～4:00之间,HR与SV分布趋势存在分离现象。

Objective The trial was designed to observe the hemodynamic circadian rhythm in serious heart failure. Methods Totally 140 cases were assigned into the trial; 120 cases of serious heart failure were into the heart failure group and 20 cases without heart failure into the control group. Heart rate （HR） and stroke volume （SV）were measured per hour during hospitalization. Results Circadian rhythm existed in two groups, but the heart rates were faster and the stroke stroke volumes lower in the heart failure group. As a whole, the HR and SV were positively correlative in two groups. But the cures of heart rate and stroke volume were separate between 1：00-4：00 before dawn in the heart failure group. The heart rate descended, while stroke volume rose. Conclusion There is divergence phenomenon between heart rate and stroke volume before dawn in serious heart failure.