老年收缩期高血压心率变异性及其临床意义

Analysis of Heart Rate Variability and Its Clinical Significance in The Elderly with Isolated Systolic Hypertension

目的探讨心率变异性（ＨＲＶ）分析在老年收缩期高血压（ＩＳＨ）中的临床意义。方法检测６５例ＩＳＨ患者，５８例健康老年组和６２例中、青年对照组ＨＲＶ的时域和频域指标并进行对比。各组间差异采用两样本均数ｔ检验。结果ＩＳＨ的正常Ｒ－Ｒ间期标准差（ＳＤ）、连续５ｍｉｎ正常Ｒ－Ｒ间期均值标准差（ＳＤＡ）、相邻正常Ｒ－Ｒ间期差值均方根（ＲＭＳＳＤ）、相邻正常Ｒ－Ｒ间期超过５０ｍｓ的百分比（ＰＮＮ５０）、高频带（ＨＦ）和低频带（ＬＦ）均显著低于健康老年组（Ｐ＜０．０５～０．０１）。ＩＳＨ组中的以上各参数Ⅲ期组显著低于Ⅱ期组（Ｐ＜０．０５～０．０１），Ⅱ期组又明显低于Ⅰ期组（Ｐ＜０．０５）。ＩＳＨ伴心肌缺血组的频域参数显著低于不伴心肌缺血组（Ｐ＜０．０１），而伴左室肥厚（ＬＶＨ）组与不伴ＬＶＨ组的ＨＲＶ差异无显著性（Ｐ＞０．０５）。结论自主神经功能紊乱在ＩＳＨ发病机制中可能起一定的作用；

Objective\ To study the clinical significance of heart rate variability(HRV) analysis in isolated systolic hypertension(ISH) in the elderly.\ Methods\ Time domain indices and spectral domain indices of HRV were assessed in 65 patients with ISH,58 healthy old subjects and 62 healthy adult subjects.\ T test was used for results statistics.\ Results\ HRV was obtained from 24 hour ambulatory electrocardiogram recording.\ Standard deviation of all normal R R intervals(SD),standard deviation of the average normal R R intervals for 5 minute segments(SDA),root mean square successive difference(RMSSD),% of difference between adjacent normal R R interval >50 ms(PNN50),high frequence segment(HF) and low frequence segment(LF) were significantly lower in patients with ISH than in healthy old subjects(P<0 05～0 01).\ These indices were markedly lower in patients with 3 phase ISH than in patients with 2 phase ISH(P<0.05～0.01),and significantly lower in 2 phase than in 1 phase too(P<0.05).\ HF and LF were markedly lower in patients with ISH with myocardial ischemia than in patients with ISH with no myocardial ischemia(P<0.01).\ However,there was no statistical difference in these indices of HRV between LVH group and no LVH group(P>0.05).\ Conclusion\ Disfunction of autonomic nervous system may play some role in etiopathogenesis of ISH;HRV may be one of the prognostic predictors in patients with ISH.