经皮球囊二尖瓣成形术对心率变异的影响

The Influence of Percutaneous Balloon Mitral Valvuloplasty on Heart Rate Variability

为了解经皮球囊二尖瓣成形术（ＰＢＭＶ）对风湿性心脏病二尖瓣狭窄病人心率变异（ＨＲＶ）的影响，自同期行ＰＢＭＶ的７１例病人中选择窦性心律者作为观察对象。于术前二日和术后第三日记录５ｍｉｎ的心搏数，经短时ＨＲＶ软件分析。结果表明术后ＲＲ间期均值标准差（３３．１８±１０．４２ｍｓｖｓ４２．８０±１５．８４ｍｓ，Ｐ＜０．０５）、相邻ＲＲ间期差值的均方根（２９．６１±１３．３８ｍｓｖｓ３７．５２±２６．０８ｍｓ，Ｐ＜０．０５）、相邻ＲＲ间期差值大于５０ｍｓ的百分比（６．７６±７．４９％ｖｓ９．０３±１０．２３％，Ｐ＜０．０１）、高频能谱（６１５．５８±４８５．６２ｂｐｍ２ｖｓ７０１．９７±６４９．９６ｂｐｍ２，Ｐ＜０．０５）均明显增大或升高。而平均心率（７４．３２±１１．３７ｂｐｍｖｓ６５．８８±７．７３ｂｐｍ，Ｐ＜０．０１）、最大心率（９５．６８±２８．６８ｂｐｍｖｓ７６．１４±８．５３ｂｐｍ，Ｐ＜０．０１）、低频能谱（４３８．２２±４０９．３１ｂｐｍ２ｖｓ２４０．１８±１９８．６８ｂｐｍ２，Ｐ＜０．０１）、极低频能谱（９７１．７４±５２９．５３ｂｐｍ２ｖｓ７２１．４３±５６４．０９ｂｐｍ２，Ｐ＜０．０１）均明显降?

The study was aimed to investigate the influence of percutaneous balloon mitral valvulopasty (PBMV) on heart rate variability (HRV).Of 71 rheumatic mitral stenosis patients who were performed PBMV,28 patients with sinus heart rate were selected to observe the difference of HRV before and after PBMV.Five minute electrocardiographic tracing was obtained the day before PBMV and three days after PBMV.The parameters of time domain and frequency domain were measured by computer.The results showed that the following time domain and frequency domain parameters increased significantly after PBMV:(1)The standard deviation of average RR intervals (33 18±10 42 ms vs 42 80±15 84 ms, P <0.05),(2)The root mean sequare of successive difference of RR intervals (29 61±13 38 ms vs 37 52±26 08 ms, P <0.05),(3)The percentage of difference between normal RR interval>50 ms(6 76± 7 49 % vs 9 03± 10.23 %, P <0.01),(4)The high frequency energy spectrum (615 58±485 62 bpm 2 vs 701 97±649 96 bpm 2, P <0.05);but the following parameters decreased significantly after PBMV:(1)The mean heart rate (74.32±11.37 bpm vs 65.88±7.73 bpm, P <0.01),(2)The maximal heart rate (95.68±28.68 bpm vs 76.14±8.53 bpm, P <0.01),(3)The low frequency energy spectrum (438.22±409.31 bpm 2 vs 240.18±198.68 bpm 2, P <0.01),(4)The very low frequency energy spectrum (971.74±529.53 bpm 2 vs 721.43±564.09 bpm 2, P <0.01).The main influence of PBMV on HRV was to make parasympathetic activity increase and sympathetic activity decrease,which was consistent with the changes of hemodynamics and improvement of clinical symptoms.These changes might be used as a noninvasive marker to estimate the effect of PBMV.