心脏移植术后患者无创心电自主神经功能指标分析

Analysis of Autonomic Nervous Function by Non-invasive Electrocardiogram in Patients After Heart Transplantation

目的:探讨心脏移植术后患者无创心电检测中的心率减速力(DC)、心率加速力(AC)、心率变异性(HRV)等自主神经功能指标与健康人群的差异。方法:回顾性收集2017年1月至2021年12月于中国医学科学院阜外医院就诊的心脏移植术后患者89例(心脏移植术组),所有患者均于移植术后1个月以上行24小时长程动态心电图和超声心动图检查。另选取100例同期体检有动态心电图和超声心动图检查结果的健康人作为对照组。比较分析两组患者的DC、AC、HRV[包括主要指标全部窦性心搏RR间期标准差(SDNN)]等自主神经功能指标。结果:心脏移植术组患者年龄(50.6±13.7)岁,男性72例(80.9%);对照组年龄(41.9±10.2)岁,男性70例(70.0%)。心脏移植术组患者平均心率[(85.3±12.6)次/min vs.(74.1±7.5)次/min]、最慢心率[(69.5±14.9)次/min vs.(49.9±5.5)次/min]均高于对照组,最快心率低于对照组[(110.2±18.9)次/min vs.(123.1±9.9)次/min],DC[(2.8±1.0)ms vs.(7.4±1.4)ms]、AC[(-3.0±1.2)ms vs.(-8.0±1.6)ms]绝对值、SDNN[(64.6±28.9)ms vs.(141.4±33.2)ms]也均低于对照组,差异均有统计学意义(P均<0.05)。心脏移植术组中10例(11.2%)患者SDNN正常,4例(4.5%)DC值正常。心脏移植术组患者SDNN与术后随访时长(月)呈正相关(P<0.05),与DC、AC无明显相关性。结论:心脏移植术后患者心率较健康人增快,DC、AC、HRV等自主神经功能指标明显降低。SDNN随着术后生存时间延长呈增加趋势,DC和AC则无明显变化。

Objectives:To explore the status of autonomic nervous function indexes such as heart rate deceleration capacity(DC),acceleration capacity(AC)and heart rate variability(HRV)in patients after heart transplantation.Methods:A total of 89 patients who underwent heart transplantation in Fuwai Hospital of Chinese Academy of Medical Sciences from January 2017 to December 2021 were retrospectively observed(heart transplantation group).100 healthy people who underwent physical examination during the same period were selected as control group.All patients underwent 24-hour long-range dynamic electrocardiogram and echocardiography at more than one month after transplantation.The electrocardiogram indexes of autonomic nerve function were compared between the two groups.Results:There were 72 males(80.9%)in the heart transplantation group,with an average age of(50.6±13.7)years.In the control group,there were 70 males(70.0%),and mean age was(41.9±10.2)years old.The mean heart rate([85.3±12.6]beats per minute[bpm]vs.[74.1±7.5]bpm)and slowest heart rate([69.5±14.9]bpm vs.[49.9±5.5]bpm)were higher in the heart transplantation group than in the control group,but the fastest heart rate in the heart transplantation group was lower than that in the control group([110.2±18.9]bpm vs.[123.1±9.9]bpm).DC([2.8±1.0]ms vs.[7.4±1.4]ms),the absolute value of AC([-3.0±1.2]ms vs.[-8.0±1.6]ms),the standard deviation of normal to normal(SDNN,the main HRV indicator,[64.6±28.9]ms vs.[141.4±33.2]ms)were significantly lower in the heart transplantation group than in the control group(all P<0.05).In the heart transplantation group,10 patients(11.2%)had normal SDNN and 4 patients(4.5%)had normal DC value.Postoperative time(number of months post operation)was positively correlated with SDNN(P<0.05),but had no correlation with DC and AC.Conclusions:Compared to healthy individuals,the heart rate is higher,and the autonomic nervous function indexes such as DC,AC and HRV are lower in patients after heart transplantation.SDNN shows an increasing trend as postoperative time increases,while DC and AC remain unchanged post operation.