动态记录24小时心电图心率变异性及其昼夜节律的逐日重复性及稳定性研究

Evaluation of reproducibility and stability of day-to-day heart rate varlability and its circadian pattern by ambulatory electrocardiogram recording.

目的 了解动态记录条件下各种非周期性的波动或干扰对 Ｈ Ｒ Ｖ 及其昼夜节律重复性及稳定性的影响程度。方法 ２３ 例接受连续４８ 小时动态心电图记录，比较重复检测时域分析各指标相关系数及相对误差（ Ｒｅｌａｔｉｖｅ Ｅｒｒｏｒ Ｒ Ｅ＝ （ Ａ－ Ｂ）／［（ Ａ＋ Ｂ）／２］）结果 ①动态记录２４ 小时心电图 Ｈ Ｒ Ｖ时域分析具有可重复性。各指标重复检测结果的相关系数在０７４～０９５ 之间，甚至ｐ Ｎ Ｎ５０ 相关系数也达０８１。两次检测ｐ Ｎ Ｎ５０ 的 Ｒ Ｅ（ Ｒｅｌａｔｉｖｅ Ｅｒｒｏｒ Ｒ Ｅ＝ （ Ａ－ Ｂ）／［（ Ａ＋ Ｂ）／２］）均值为 ０５０，其余指标在００５～０１６ 之间。②非心梗受检者动态记录心电图 Ｈ Ｒ Ｖ昼夜节律明显且具有可重复性。但１ 小时节段心电图 Ｈ Ｒ Ｖ重复检测相关性较全程减低，波动增大。夜间重视检测ｒ Ｍ Ｓ Ｓ Ｄ 及ｐ Ｎ Ｎ５０ 相关性较白天高、波动减小。结论 ①非心梗受检者动态记录心电图 Ｈ Ｒ Ｖ时域分析具有可重复性及稳定性， Ｓ Ｄ Ｎ Ｎ、 Ｓ Ｄ Ｎ Ｎｉｎｄｅｘ 和ｒ Ｍ Ｓ Ｓ Ｄ 为优选指标。②非心梗受检者 Ｈ Ｒ Ｖ 昼夜节律明显且具有可重复性。其中，反映高频心率波动的指标ｒ Ｍ Ｓ Ｓ Ｄ 和ｐ Ｎ ?

Objective To determine the reproducibility and stability of HRV in non-AMI subjects with ambulatory ECG recording.Methods 23 patients received Holter examinations in 2 successive days.Time domain HRV indices were compared to show the correlation and relative error(RE=A-B/[(A+B)/2])of the two measurements.Results (1)Time domain analysis of long-term (24h) HRV for this group of patients was reproducible.The successive two measurements of all indices showed good correlation(r=0.74 to 0.95),even that of pNN50 correlated with each other well(r=0.81).The mean value of relative error (RE=(A-B)/[(A+B)/2] of time domain indices ranged from 0.05 to 0.16 except for pNN50 the RE of which was 0.50.(2)Circadian variation was evident in most HRV indices and was of the same pattern in 2 successive days.The hourly values of rMSSD and pNN50 had more day-to-day variation during daytime,though they were more stable at night.Conclusion Time domain analysis of HRV was reproducible and stable in ambulatory non-AMI subjects.rMSSD and pNN50 measured at nighttime were more stable than that during daytime.The reproducibility and stability of 24-hour period HRV assessment was significantly higher than any short period HRV measures within the same day.