急性脑出血患者24小时心率变异性变化与动态心电图异常

Abnormal dynamic electrocardiogram and heart rate variability in patients with acute cerebral hemorrhage

目的 了解急性脑出血对心脏自主神经活性改变、心电图复极改变和心律失常的影响。方法 检测61例急性大脑半球壳核和额顶颞叶出血患者和39例对照的24 h动态心电图,分析其心率变异性变化、心电图复极改变和心律失常。结果 右侧壳核和额顶颞叶出血患者急性期室上性快速心律失常和心房颤动发生率明显增高;左侧壳核和额顶颞叶出血患者急性期心电图ST段降低发生率明显增高。右侧壳核和额顶颞叶出血组心率变异性指标HF、RMSSD、PNN50明显下降和LF/HF明显增高。伴室上性快速心律失常者LF/HF高于无室上性快速心律失常者,HF明显低于无室上性快速心律失常者。结论 左侧和右侧大脑半球出血对心脏的影响不同,岛叶病变在其中起着主要作用。

Objective The present study was attempted to assess the effect of lesions of cerebral hemorrhage on cardiac damages and cardiac autonomic nervous activity.Methods Twenty-four hour dynamic electrocardiogram (ECG) recordings was measured in 61 patients with hemispheric cerebral hemorrhage in the acute phase and in 39 control subjects.Time domain,power spetral components of heart rate variability(HRV)were measured with 24-hour dynamic EOG recordings in 55 patients with hemispheric cerebral hemorrhage and in 39 control subjects.Results Supraventricular arrhythmias was significantly increased in groups of right putamental and frontoparietotemporal hemorrhage compared with left putamental and frontoparietotemporal hemorrhage(P<0.05) and the controls(P< 0.01) .An significantly increased rate of ST segment abnormality was found in groups of left putamental and frontoparietotemporal hemorrhage compared groups of right putamental and frontoparietotemporal hemorrhage (P = 0.006).The measured components of HRV,ie,high frequency power(HF),RMSSD,and PNN50 were significandy lower,LF/HF were significantly higher in groups of right putamental and frontoparietotemporal hemorrhage in acute phase compared with control group.Conclusions The effects of hemispheric cerebral hemorrhage on heart function and cardiac autonomic nervous activity mainly are correlated with destruction of insular or regions adjacent to the insular.