间歇性迷走神经刺激对未成年难治性癫痫患者自主心率变异性影响

The effect of intermittent vagus nerve stimulation on refractory epilepsy on heart rate variability in minor patients

目的探讨难治性癫痫儿童与青少年的自主心率变异情况及迷走神经刺激术(VNS)对心率变异性的影响。方法选择15例患有难治性癫痫症的儿童为癫痫组,选择非癫痫但患有多动症与认知障碍的儿童15例为对照组,在进行VNS前后分别获取睡眠第2阶段与慢波睡眠期间的脑电图与心电图数据,利用时域分析法对相关指标进行分析。结果在睡眠第2阶段与慢波睡眠期间,癫痫组较对照组心率差异均有统计学意义(P<0.01)。但VNS治疗前后平均RR间期差异无统计学意义(P>0.05),说明VNS并没有改变难治性癫痫患者的心率。在VNS治疗前,睡眠第2阶段SDNN、SDANN、RMSSD、PNN50与对照组差异无统计学意义,但经VNS治疗后,SDANN与PNN50较对照组降低且差异有统计学意义(P<0.05),SDNN与RMSSD降低水平有统计学意义(P<0.01)。结论心脏自主控制受难治性癫痫症的影响,VNS可诱导交感平衡系统向着交感神经占优势的转变和提高自主调制能力。

Objective To explore the heart rate variability in minor patients with refractory epilepsy and the influence of vagus nerve stimulation（VNS） on this parameter.Methods 15 minor patients（12 male,3 female;mean age 9.5 year-old;age range 6-16 year-old） with refractory epilepsy,electroencephalographic and electrocardiographic data were obtained before and after implantation of VNS during stage 2 and slow-wave sleep.Time domain parameters were calculated and the results were compared with an age-and sex-matched group of minor patients without refractory epilepsy.Results Time domain analysis showed that heart rate was significantly higher in minor patients with epilepsy than in the comparison group in stage 2 sleep and during slow-wave sleep（P0.01）.Before VNS therapy,there was no significant difference of SDNN,SDANN,RMSSD,and PNN50 between minor patients with epilepsy and the comparison group during the second sleep phase.After VNS therapy,SDANN and PNN50 were lower,there was significantly difference（P0.05 vs.control group）,SDNN and RMSSD were lower,there was a statistically significant difference（P0.01）.Conclusion Heart rate variability is affected in minor patients with refractory epilepsy.Implantation of VNS induces a shift in sympathovagal balance towards sympathetic predominance and an improvement in autonomic modulation.