入院时24 h心率变异性与慢性心力衰竭病人低血压的关系

Relationship between 24-hour Heart Rate Variability and Hypotension in Patients with Chronic Heart Failure during Hospitalization

目的:探讨入院时24 h心率变异性与慢性心力衰竭(CHF)病人住院期间发生低血压的关系。方法:选取2019年5月—2022年7月我院收治的CHF病人作为研究对象,入院当日采用24 h动态心电图测定病人心率变异性,根据住院期间病人低血压发生情况将病人分为发生组与未发生组。比较两组一般资料、心脏超声指标及入院时24 h心率变异性;采用Pearson法分析发生组病人24 h心率变异性与血压的相关性;采用Logistic回归分析24 h心率变异性与CHF病人发生低血压的关系;绘制受试者工作特征(ROC)曲线,分析24 h心率变异性对CHF病人住院期间发生低血压的预测价值。结果:共纳入112例CHF病人,其中男61例,女51例;年龄57~79(68.17±2.98)岁;病人住院期间低血压发生率为14.29%。发生组入院时24 h窦性R-R间期总体标准差(SDNN)、正常相邻窦性R-R间期差值均方根(rMSSD)、正常相邻R-R间期差值>50 ms百分比(pNN50)、低频(LF)、LF/高频(HF)低于未发生组,差异均有统计学意义(P<0.01)。Pearson相关性分析显示,发生组入院时24 h心率变异性指标SDNN、rMSSD、pNN50、LF、LF/HF与发生低血压时收缩压、舒张压均呈正相关(P<0.05)。Logistic回归分析结果显示,入院时rMSSD、pNN50、LF/HF是CHF病人住院期间发生低血压的影响因素(P<0.05)。ROC曲线分析显示,入院时SDNN、rMSSD、pNN50、LF、LF/HF预测CHF病人住院期间发生低血压的ROC曲线下面积(AUC)>0.70,具有一定的预测价值,联合预测的AUC>0.90,预测价值高。结论:24 h心率变异性是CHF病人住院期间发生低血压的影响因素,可预测CHF病人住院期间低血压的发生。

Objective:To investigate the relationship of 24-hour heart rate variability and hypotension in patients with chronic heart failure(CHF)during hospitalization.Methods:The patients with CHF admitted to our hospital from May 2019 to July 2022 were prospectively selected as the study objects.The heart rate variability of the patients was measured by 24-hour Holter electrocardiogram on the day of admission,and the patients were divided into the occurrence group and non-occurrence group according to the occurrence of hypotension during hospitalization.The general data,echocardiographic indexes and 24-hour heart rate variability at admission were compared.Pearson method was used to analyze the correlation between 24-hour heart rate variability and blood pressure.Logistic regression analysis was used to examine the relationship of 24-hour heart rate variability and hypotension in CHF patients.The receiver operating characteristic(ROC)curve was drawn to analyze the predictive value of 24-hour heart rate variability for hypotension during hospitalization in CHF patients.Results:A total of 112 patients with CHF were included,including 61 males and 51 females,the average age was 57 to 79(68.17±2.98)years old,and the incidence of hypotension during hospitalization was 14.29%.Twenty-four hour standard diviation of NN intervals(SDNN),root mean square of normal adjacent sinus R-R interval difference(rMSSD),percentage of normal adjacent R-R interval difference>50 ms(pNN50),low frequency(LF)and LF/high frequency(HF)decreased in the occurrence group than those in the non-occurrence group(P<0.01).The results of Pearson correlation test showed that 24-hour heart rate variability indexes SDNN,rMSSD,pNN50,LF,and LF/HF were positively correlated with systolic blood pressure and diastolic blood pressure(P<0.05).Logistic regression analysis showed that low rMSSD,pNN50 and LF/HF at admission were the influential factors for hypotension in CHF patients during hospitalization(P<0.05).The ROC curve showed that the AUC of SDNN,rMSSD,pNN50,LF and LF/HF in predicting hypotension of CHF patients during hospitalization was more than 0.70,which should certain predictive value.AUC of combined prediction was more than 0.90,which should high predictive value.Conclusion:Twenty-four hour heart rate variability was an influencing factor for hypotension in CHF patients during hospitalization,and could be used as a predictor of hypotension in CHF patients.