老年冠心病并存焦虑或抑郁患者自主神经功能的变化

Changes of autonomic nervous function in elderly patients with coronary heart disease accompanying anxiety or depression

目的 探讨老年冠心病并存焦虑和（或）抑郁障碍患者自主神经功能的变化及临床意义.方法 85例经选择性冠状动脉造影确诊为冠心病的老年住院患者,通过焦虑自评量表及抑郁自评量表问卷调查分为焦虑组（32例）、抑郁组（28例）和对照组[不伴焦虑和（或）抑郁的单纯冠心病患者,25例].应用动态心电图系统采集患者心电信号进行心率变异性分析.结果 与单纯冠心病患者比较,并存焦虑和（或）抑郁障碍冠心病患者的24 h内全部正常心动周期的标准差、相邻正常心动周期差值的均方根、相邻两个正常心动周期差值大于50 ms的个数所占的百分比和高频能显著降低.与对照组低频能[（295.4±70.0）Hz]比较,冠心病并存焦虑患者显著增高[（348.2±70.6）Hz],而高频能降低[分别为（77.9±13.7）、（65.5±14.4）Hz],差异具有统计学意义（t值分别为2.78、-3.16,均P〈0.05） 冠心病并抑郁患者低频能显著增高[（350.7±65.3）Hz],而高频能显著降低[（66.1±16.4）Hz],差异具有统计学意义（t值分别为2.95、-2.98,均P〈0.05）.焦虑、抑郁两组间相应参数比较差异无统计学意义.结论 并存焦虑和（或）抑郁障碍的老年冠心病患者迷走神经功能受损明显,自主神经功能严重失调,积极纠正焦虑和（或）抑郁障碍可能有助于改善老年冠心病患者的预后.

Objective To observe the changes of autonomic nervous function in elderly patients with coronary heart disease （CHD） accompanying anxiety or depression, and to explore their clinical significance. Methods The 85 elderly inpatients with CHD, diagnosed by selective coronary angiography, were divided into anxiety group （32 cases）, depression group （28 cases） and control group （simple CHD without anxiety or depression, 25 cases）. The heart rate variability （HRV） was analyzed according to electrocardiograph detected by dynamic cardiograms. Results Compared with the controls, the standard deviation of normal to normal intervals （SDNN）, the rate mean square of the differences of successive RR intervals （rMSSD）, the percentage of RR intervals differing 〉 50 ms （PNN50） and the high frequency （HF） decreased markedly in patients with CHD accompanying anxiety or depression, and the low frequency （LF） increased significantly in anxiety group than in control group [（348. 2 ± 70. 6） Hz vs. （295.4＋70.0） Hz, t=2.78,P〈0.05], while the HF decreased significantly [（65. 5±14. 4） Hz vs. （77.9± 13. 7） Hz, t=3.16,P〈0. 05]. There were no significant differences between the anxiety group and depression group in the corresponding parameters. Conclusions The injury of vagus nerve function, also autonomic nerve system dysfunction are more seriously in patients with CHD accompanying anxiety or depression than with simple CHD. Actively treating patients with CHD accompanying anxiety or depression may improve their prognosis.