老年高血压患者窦性心率震荡的研究

Investigation on heart rate turbulence in elderly patients with hypertension

目的研究老年高血压患者心率震荡(HRT)的特点,评估HRT指标对老年高血压患者心脏自主神经功能损害的价值。方法选择老年高血压患者58例作为观察组,再根据血压昼夜节律特点,分为3个亚组:杓型组17例,非杓型组22例,反杓型组19例,选择体检健康者18例作为对照组。比较组间震荡初始(TO)和震荡斜率(TS),分析TO、TS与24h平均收缩压、舒张压、脉压、心率变异性的相关性。结果观察组TO(%)[-7.1～6.8(-0.3)]>对照组[-5.8～-0.1(-1.9)](P<0.01),TS(ms)(7.53±4.05)<对照组(10.01±3.72)(P<0.05);非杓型组和反杓型组TO[分别为-6.7～6.5(-0.3),-7.1～6.8(0.5)]>对照组[-5.8～-0.1(-1.9)](P<0.05),非杓型组TS(6.79±2.99)<对照组(10.01±3.72)(P<0.05),反杓型组TS(6.51±3.71)<对照组(10.01±3.72)(P<0.01);TO与总体标准差(SDNN)呈负相关(P<0.05);TO与平均值的标准差(SDANN),TS与SDNN、SDANN无相关性(P>0.05);TO、TS与24h平均收缩压、舒张压、脉压均无相关性(P>0.05)。结论老年高血压患者HRT指标较对照组差异具有统计学意义,血压昼夜节律异常患者HRT明显减弱。提示HRT在评估老年高血压患者心脏自主神经功能损害方面具有一定价值。

Objective To investigate characteristics of heart rate turbulencer （HRT）in elderly patients with hypertension to evaluate significance of HRT on cardiac autonomic nerves dysfunction. Methods 58 patients, 17 patients with dippers,22 patients with non-dippers, 19 patients with reverse-dippers, 18 healthy people as control. Turbulence onset（TO）and turbulence slope （TS）were measured among four groups ,and relativities were analyzed between TO ,TS and the 24 hour mean systolic, mean diastolic, mean pulse pressure and heart rate variability. Resets TO was significantly higher [-7.1 -6.8 （-0.3）] in patients than in healthy people [-5.8--0.1 （-1.9） ] （P〈0.01）. TS was significantly lower in patients （7.53±4.05）than in healthy people （ 10.01±3.72） （P〈 0.05） ; TO was significantly higher in patients with non-dippers -6.7-6.5 （-0.3） and reverse-dippers -7.1-6.8 （0.5）than in healthy people[-5.8- -0.1 （-1.9）] （P〈0.05）. TS was significantly lower in patients with non-dippers （6.79±2.99）than in healthy people （10.01±3.72）（P〈0.05） ;TS was significantly lower in patients with reverse-dippers（6.51±3.71 ） than in healthy people（10.01±3.72） （P〈0.01）; TO is negatively correlation to SDNN（P〈0.05）. TO is irrelative to SDANN,and ＇IS is irrelative to SDNN and SDANN（P〉 0.05）,TO,TS is irrelative to 24 hour mean systolic,mean diastolic and mean pulse pressure（P〉0.05）. Conclusions Statistics significance was found in the variables of HRT in the elderly patients with hypertension and significance decreased in patients of abnormal blood pressure circadian rhythm. HRT can be used as an evaluation of cardiac autonomic nerves dysfunction in elderly patients with hypertension.