房间隔缺损经导管封堵术对心率变异性的影响及意义

The effect and significance of transcatheter closure on heart rate variability in patients with atrial septal defect

目的探讨房间隔缺损(ASD)经导管封堵术对心率变异性(HRV)的影响及意义。方法选择成功接受介入治疗的ASD患者118例为研究对象(ASD组),分别于术前1天及术后第4天记录24h动态心电图,由电脑自动分析并经心电专业人员校正,得出HRV的各项时域指标;另按术前心脏超声测得的肺循环血流量/体循环血流量(Qp/Qs)分为Ⅰ组(Qp/Qs<1.5)与Ⅱ组(Qp/Qs≥1.5),分析两亚组患者HRV,并行Qp/Qs与HRV的相关性分析。结果与对照组比较,ASD组封堵术前后24hRR间期标准差(SDNN)及24h内每5min节段RR间期均值标准差(SDANN)均显著降低(P<0.01或0.05);Ⅱ组降低更明显。ASD组封堵术后RR间期、SDNN及SDANN均较术前增加(P<0.05);Ⅱ组介入治疗术后的SDNN、ASDNN较Ⅰ组术后明显减小(P<0.05)。ASD患者术前SDNN及SDANN与Qp/Qs呈负相关(r值分别为-0.528、-0.644,P<0.01)。结论ASD封堵术后HRV水平明显恢复;Qp/Qs越大的ASD患者不仅术前HRV水平降低更显著,术后的恢复也越慢。

Objective To discuss the effect and significance of transcatheter closure on heart rate variability（HRV） in patients with atrial septal defect（ASD）. Methods 118 cases accepting successful transcatheter closure were analyzed. Echocardiography and 24-hour record of Holter were taken at 1 day before and 4 days after transcatheter closure. The Holter results were automatically analyzed by computer and then corrected by professional electrocardiogram technician. The parameters of time domain of HRV and the ratio of pulmonary flow to systemic blood flow（ Qp/Qs, group Ⅰ： Qp/Qs 〈 1.5 ; group Ⅱ ： Qp/Qs 〉 1.5） were analyzed. Results Compared to control, SDNN and SDANN were significantly decreased （ P 〈 0. 01 or 0. 05 ）, and more statistically significant in group Ⅱ. RR interval, SDNN and SDANN increased significantly after transcatheter closure（P 〈 0. 05）. After transcatheter closure, SDNN and SDANN in group Ⅱ be came much shorter than in group Ⅰ （ P 〈 0. 05 ）. Standard deviation of all NN intervals （SDNN） and standard deviation of the averages of NN intervals in all 5 min segments of the entire recording（SDANN） showed a negative correlation with Qp/Qs before transcatheter closure, the correlation coefficient was - 0. 528 and - 0. 644 （ respectively P 〈 0. 01 ）. Conclusion HRV recovers quickly after transcatheter closure of ASD. HRV of ASD patients with higher Qp/Qs not only decreases more significantly but also recovers slower.