心率变异性对急性脑卒中患者心脏自主神经功能的评估价值

Assessment value of heart rate variability for cardiac autonomic nervous function in patients with acute stroke

目的:探讨动态心电图心率变异性指标对急性脑卒中患者心脏自主神经功能评估的价值。方法:选择我院收治的80例急性脑卒中患者(脑卒中组),同期80例住院非心脑血管疾病的患者(对照组),采用Holter记录仪对两组患者进行24h心率动态监测,对比两组监测结果。结果:与对照组比较,脑卒中组24h窦性R-R间期的标准差[SDNN,(129.89±5.42)ms比(92.58±4.36)ms]、24h每5min窦性R-R间期平均值的标准差[SDANN,(118.85±5.79)ms比(77.36±4.82)ms]、相邻窦性R-R间期的均方根[rMSSD,(27.04±1.18)ms比(7.31±1.09)ms]以及相邻正常R-R间期差值>50ms的心搏数占24h总R-R间期数的百分比[PNN50,(8.97±1.48)%比(2.62±0.54)%]均明显下降(P均<0.01);而脑卒中患者中脑梗死与脑出血患者上述指标比较差异均无统计学意义(P均>0.05)。结论:心率变异性指标在评估急性脑卒中患者心脏自主神经功能方面有重要价值,能对患者的病情变化和发展做出预测,有助于预防和发现严重脑血管疾病。

Objective： To explore assessment value of heart rate variability （HRV） of Holter for cardiac autonomic nervous function in patients with acute stroke. Methods： A total of 80 cases with acute stroke treated in our hospital were regarded as stroke group, and another 80 inpatients without cardio- and cerebrovascular diseases were enrolled as control group simultaneously. Holter was used to perform 24h ambulatory heart rate monitoring on two groups, and the results were compared between two groups. Results： Compared with control group, there were significant reductions in standard deviation of normal to normal RR intervals calculated over the 24 h period ESDNN, （129.89 ± 5.42） ms vs. （92.58 ±4. 363 ms], standard deviation of normal to normal RR intervals in all 5 min segments of the entire recording [SDANN, （118.85 ± 5.79） ms vs. （77.36 ± 4.82） ms], root-mean square of differences between successive normal to normal intervals [rMSSD, （27.04 ± 1.18） ms vs. （7. 31 ± 1.09） ms] and adjacent normal RR interval difference 〉50ms stroke accounted for a percentage of 24h total RR interval [-PNN50, （8.97± 1.48）% vs. （2.62 ± 0.54）%] in stroke group, P〈0.01 all; in stroke patients, there were no significant difference in above indexes between cerebral infarction patients and cerebral hemorrhage patients, P〉0.05 all. Conclusion： HRV indexes possess significant assessment value for cardiac autonomic nervous function in patients with acute stroke. They can predict patient＇s status changes, and help to prevent and identify severe cerebrovascular disease in time.