20例冠心病痰热证患者的心率变异性观察分析

Explorative Research on Heart Rate Variability of Coronary Heart Disease of Different Chinese Medicine Syndromes

目的通过对冠心病痰热证和血瘀证患者的心率变异性(HRV)相关时域指标的观察分析,探讨冠心病痰热证患者的心脏自主神经功能改变特点。方法共收集经冠脉造影或既往心肌梗死等确诊的冠心病患者35例,经中医辨证后,分为痰热证组20例,血瘀证组15例,并对两组患者进行24 h动态心电图(Holter)检查,对比分析两组患者的心率变异性(HRV)改变特点。结果冠心病痰热证组患者的HRV指标:24 h所有正常窦性心律NN间期的标准差(SDNN)及每5分钟NN间期均值的标准差(SDANN)均低于血瘀证组;而相邻NN间期差值的均方根值(RMSSD)以及相邻NN间期差值>50 ms的心搏数占总心搏数的百分比(PNN50),痰热证组均高于血瘀证组。但四项指标比较,差异均无统计学意义(P>0.05)。结论冠心病痰热证患者可能存在交感神经兴奋趋势,而血瘀症患者可能偏于迷走神经兴奋。

Objective To explore the change character of autonomic nervous function of the heart in the patients of coronary heart disease（CHD）of phlegm heat syndrome through the observation and analysis of the relevant time-domain indexes of heart rate variability（HRV）of CHD of phlegm heat syndrome and blood stasis syndrome.Methods 35 cases of CHD diagnosed firmly by coronarography or past myocardial infarction were collected.After syndrome differentiation in Chinese medicine,they were divided into phlegm-heat syndrome group（20 cases）and blood-stasis syndrome group（15 cases）.Holter test was monitored for 24 h in two groups and the change characters of HRV were compared and analyzed.Results It was found for HRV indexes of the patients in phlegm-heat syndrome group that SDNN of sinus rhythm and SDANN at the interval of 5min were all lower than those in blood-stasis syndrome group,and adjacent RMSSD and adjacent PNN50 were higher than those in blood-stasis syndrome group.But the comparison of the four indexes did not present significant statistical difference（P0.05）.Conclusion The patients with CHD of phlegm heat syndrome present the excitatory trend of sympathetic nerve,and those of blood stasis syndrome may indicate the excitement of vagus nerve system.