动态心电图对频发室性早搏患者心率变异性的诊断价值研究

Study on value of dynamic electrocardiogram in the diagnosis of heart rate variability of patients with frequent ventricular premature beats

目的探讨动态心电图对频发室性早搏患者心率变异性的诊断价值。方法75例频发室性早搏患者作为研究对象,均行动态心电图检查。分析频发室性早搏患者的动态心电图检查结果,比较心率变异减小和心率变异正常患者的时域指标[24 h内相邻R-R间期的总体标准差(SDNN)、5 min内相邻R-R间期的均值标准差(sDANN)、相邻R-R间期的差值均方根(rMSSD)、相邻R-R间期的差值>50 ms的百分比(PNN50)]和频域指标[极低频功率(VLF)、低频功率(LF)、高频功率(HF)、低频与高频功率比值(LF/HF)]。结果75例室性早搏患者经动态心电图检查,提示心率变异减小38例(50.67%),心率变异正常37例(49.33%)。心率变异减小患者的SDNN(94.02±5.76)ms、sDANN(82.04±6.55)ms、rMSSD(26.18±4.02)ms、PNN50(9.30±1.02)%均低于心率变异正常患者的(101.31±6.59)ms、(91.02±7.87)ms、(30.51±5.17)ms、(11.97±2.82)%,差异具有统计学意义(P<0.05)。心率变异减小患者的VLF(2061.57±117.30)ms^(2)/Hz、HF(361.15±31.64)ms^(2)低于心率变异正常患者的(2305.42±192.05)ms^(2)/Hz、(505.79±42.08)ms^(2),LF/HF(2.53±0.39)高于心率变异正常患者的(1.81±0.22),差异具有统计学意义(P<0.05)。心率变异减小患者的LF与心率变异正常患者比较差异无统计学意义(P>0.05)。结论在心律失常患者的临床诊断中,通过动态心电图检查,根据心电图的变化情况,判断室性早搏的发生情况。通过对心率变异性的分析,了解患者的心脏自主神经活动,对于临床治疗工作的开展提供了重要的参考依据。

Objective To discuss the value of dynamic electrocardiogram in the diagnosis of heart rate variability of patients with frequent ventricular premature beats.Methods 75 patients with frequent ventricular premature beats were selected as the research subjects,and all of them underwent dynamic electrocardiogram.The results of dynamic electrocardiogram in patients with frequent ventricular premature beats were analyzed.The time-domain indicators[standard diviation of NN intervals(SDNN),standard diviation average of NN intervals(sDANN),root mean square of the successive normal sinus R-R interval difference(rMSSD),adjacent NN interval difference 50 ms percentage(PNN50)]and frequency-domain indicators[very low frequency(VLF),low frequency(LF),high frequency(HF),low frequency to high frequency ratio(LF/HF)].Results 75 patients with premature ventricular beats were examined by ambulatory electrocardiography,suggesting that 38 patients had decreased heart rate variability and 37 patients had normal heart rate variability.SDNN of(94.02±5.76)ms,sDANN of(82.04±6.55)ms,rMSSD of(26.18±4.02)ms and PNN50 of(9.30±1.02)%of patients with decreased heart rate variability were lower than those of(101.31±6.59)ms,(91.02±7.87)ms,(30.51±5.17)ms,(11.97±2.82)%of patients with normal heart rate variability,and the differences were statistically significant(P<0.05).VLF of(2061.57±117.30)ms^(2)/Hz and HF of(361.15±31.64)ms^(2)in patients with decreased heart rate variability were lower than those of(2305.42±192.05)ms^(2)/Hz and(505.79±42.08)ms^(2)in patients with normal heart rate variability;LF/HF of(2.53±0.39)in patients with decreased heart rate variability was higher than that of(1.81±0.22)in patients with normal heart rate variability;the differences were statistically significant(P<0.05).There was no statistically significant difference in LF between patients with decreased heart rate variability and those with normal heart rate variability(P>0.05).Conclusion In the clinical diagnosis of patients with arrhythmias,the occurrence of ventricular premature beats can be judged according to the changes of the dynamic electrocardiogram.Through the analysis of heart rate variability,the cardiac autonomic nervous activity of patients can be understood,which provides an important reference for clinical treatment.