宫内窘迫胎儿出生后心率变异性的临床研究

Heart Rate Variability of Neonates with Intrauterine Distress after Birth

目的探讨宫内窘迫胎儿出生后心率变异性(HRV)的变化特点及其临床意义。方法有宫内窘迫史的106例新生儿,根据Apgar评分分为无窒息组30例、轻度窒息组46例、重度窒息组30例,另选无宫内窘迫史的正常足月新生儿30例作对照组,于生后24 h内行动态心电图检查并分析心率变异性。结果无窒息组、轻度窒息组和对照组平均心率、最慢心率、最快心率比较,差异无统计学意义(P>0.05),重度窒息组3项指标均低于无窒息组、轻度窒息组及对照组(P<0.05)。无窒息组全部窦性心率R-R间期标准差、R-R间期均值的标准差、R-R间期标准的均值、相邻R-R间期差值的均方根、相邻R-R间期差值>50 ms心搏数的百分比与对照组相比,差异无统计学意义(P>0.05);无窒息组、轻度窒息组上述5项指标均高于重度窒息组(P<0.05)。结论宫内窘迫胎儿出生后无窒息表现的新生儿HRV指标在正常范围内,而窒息新生儿HRV指标存在不同程度降低,且窒息程度越重HRV指标越低。

Objective To investigate the change characteristics of heart rate variability（ HRV） of neonates with intrauterine distress after birth and its clinical significance. Methods One hundred and six cases who had a neonatal intrauterine distress history were divided into non-asphyxia group（ 30 cases）,mild asphyxia group（ 46 cases）,severe asphyxia group（ 30 cases）,30 normal full-term neonates without asphyxia as control group. Dynamic electrocardiogram was conducted in the neonates within 24 hours after birth for the analysis of heart rate variability. Results There were no significant differences in average heart rate,the slowest heart rate and the fastest heart rate among non-asphyxia group,mild asphyxia group and severe asphyxia group（ P 〈 0. 05）,the 3 indexes in the severe asphyxia were lower than those in the non-asphyxia group,mild asphyxia group and control group（ P 〈 0. 05）. There were no significant differences in 5 indexes（ SDNN,SDANN,SDNN,rMSSD,pNN50） between non-asphyxia group and control group（ P 〈 0. 05）,and the 5 indexes above in the non-asphyxia group,mild asphyxia group were higher than those in the severe asphyxia group（ P 〈 0. 05）. Conclusion The HRV of intrauterine distress neonate after birth without asphyxia is normal,which of neonate with asphyxia decreases in different degrees. And more severe asphyxia,lower HRV.