心率变异性指标在急性脊髓损伤患者自主神经功能中的评估价值

Evaluation value of heart rate variability index in autonomic nerve function of patients with acute spinal cord injury

目的应用心率变异性(HRV)评价急性脊髓损伤(SCI)后自主神经功能(ANS)。方法纳入符合标准的46例SCI的患者,根据其SCI的平面分为高位损伤(C1~T5)组和低位损伤组(T6~T12)组。高位损伤组24例,其中新入院12例,康复训练后12例;低位损伤组22例,其中新入院11例,康复训练后11例。另根据美国脊髓损伤学会(ASIA)残损分级再次对患者进行分组,将其分为完全性SCI组和不完全性SCI组。其中完全性SCI组19例(新入院10例,康复训练后9例);不完全性SCI组27例(新入院13例,综合康复训练后14例)。收集新入院患者(受伤3~7 d)、康复训练后(康复训练3周,受伤后27~33 d)24 h动态心电图,分析指标:高频功率(HF)、低频功率(LF)、LF/HF、超过50 ms的个数占总(PNN50)、差值均方的平方根(rMSSD)、均值标准差(SDANN)。结果新入院患者中,高位损伤组较低位损伤组LF/HF下降显著,高频指标增高更显著,完全性SCI组与不完全SCI组伤相比,HRV无论高频部分还是低频部分都不同程度降低(P<0.05);康复训练后高位损伤组与低位损伤组相比,LF/HF显著降低;完全性SCI组与不完全性SCI组相比,HRV无论高频部分还是低频部分不同程度降低;康复训练后与新入院对比,高位损伤组SDANN显著升高,不完全性SCI组SDANN显著升高,但其他各项指标变化不显著。结论急性期SCI损伤的平面越高,损伤程度越严重,此时患者自主神经系统受损越发严重;伤后1个月时完全性SCI自主神经功能恢复较差,而损伤平面较高的患者难达到交感迷走平衡,损伤平面高的患者较损伤平面低的患者副交感神经更占优势,不完全性SCI患者自主神经恢复优于较完全性SCI患者。

Objective Autonomic nervous after acute spinal cord injury(SCI) is evaluated by heart rate variability(HRV).Methods Conform to the diagnostic standard of 46 patients with acute spinal cord injury were included.higher level injury group(C1-T5)24 cases,including 12 cases on admission,12 cases after rehabilitation treatment.low level injury group(T6-T12)24 cases,including 11 cases on admission,11 cases after rehabilitation therapy,according to the American spinal injury association(ASIA) grade of damage,it can be divided into injury group and incomplete injury completely.Completely injury group of 19 cases,of which 10 cases on admission,9 cases after rehabilitation treatment.Incompletely injury group of 27 cases,of which 13 cases on admission,14 cases after rehabilitation treatment.Collected on admission(3 to 7 days after injury),after rehabilitation treatment,rehabilitation treatment for (3 weeks,27 to 33 days after injury) in patients with 24-hour dynamic electrocardiogram(ecg) as a result,the analysis indicators:high frequency(HF),low frequency(LF),PNN50,rMSSD,SDANN.Results Among the newly admitted patients,the LF/HF in the higher level injury group decreased significantly and the HF index increased more significantly than that in the low level injury group.Compared with the incomplete SCI group,the HRV in both the high and low frequencies decreased to different degrees(P<0.05).After rehabilitation treatment,the LF/HF in the high level injury group was significantly lower than that in the low level injury group,and the HRV in the complete SCI group was significantly lower than that in the incomplete SCI group.After rehabilitation treatment,SDANN was significantly increased in the high level injury group and significantly increased in the incomplete SCI group,but the changes of other indicators were not significant.Conclusion The higher the level of SCI injury in the acute stage,the more serious the injury is,and the more serious the patient’s autonomic nervous system is.At 1 month after injury,the functional recovery of complete SCI autonomic nerve was poor,while patients with higher injury plane were difficult to achieve sympathetic vagal balance,patients with higher injury plane were more dominant than patients with lower injury plane,and patients with incomplete SCI had better autonomic nerve recovery than patients with complete SCI.