急性脑梗死患者心率变异性与病情严重程度及预后的关系

The relationship between heart rate variability,severity,and prognosis in patients with acute cerebral infarction

目的探讨急性脑梗死(ACI)患者心率变异性与病情严重程度及预后的关系。方法前瞻性选择2021年2月至2023年3月秦皇岛市工人医院收治的80例ACI患者作为观察组,根据患者美国国立卫生研究院卒中量表(NIHSS)评分评定ACI患者病情严重程度,分为轻型组(26例,NIHSS评分0~15分),中型组(32例,NIHSS评分16~30分),重型组(22例,NIHSS评分31~45分);并以同期30例健康体检者作为对照组。采用改良Rankin量表(MRS)评估患者预后情况,根据评分结果分为预后良好组(59例)和预后不良组(21例)。所有患者均行动态心电图检查,比较各组心率变异性参数[24 h全部窦性心搏R-R间期标准差(SDNN)、24 h连续5 min窦性心搏R-R间期标准差的均值(SDNN Index)、每5分钟窦性心搏R-R间期均值的标准差(SDANN)、所有临近窦性心搏R-R间期差值的均方根(rMSSD)、相邻NN间期之差>50 ms的个数占比(PNN50%)],利用受试者工作特征(ROC)曲线分析心率变异性参数对ACI患者病情严重程度及预后的预测价值,采用logistic回归分析法明确ACI患者病情严重程度及预后的危险因素。结果轻型组、中型组、重型组的SDNN、SDANN、SDNN Index、rMSSD、PNN50%均显著低于对照组(F=59.382,11.859,12.376,11.699,47.703,均P<0.01),且重型组<中型组<轻型组(均P<0.05)。预后不良组的SDNN、SDANN、SDNN Index、rMSSD、PNN50%均低于预后良好组(t=4.536,4.181,5.091,4.384,2.851,均P<0.01)。Logistic回归分析结果显示:心率变异性参数是ACI患者病情严重程度及预后不良的独立影响因素(均P<0.01)。SDNN、SDANN、SDNN Index、rMSSD、PNN50%联合诊断ACI患者病情严重程度的曲线下面积为0.950,联合预测ACI患者预后的曲线下面积为0.970。结论心率变异性参数是ACI患者病情严重程度和预后的独立影响因素,且心率变异性参数对ACI患者病情严重程度和预后的预测效能均较高,可作为评估ACI患者病情严重程度和预后情况的有效指标。

Objective To explore the relationship between heart rate variability,severity,and prognosis in patients with acute cerebral infarction(ACI).Methods A prospective study was conducted on 80 patients with acute cerebral infarction(ACI)admitted to Qinhuangdao Workers′Hospital from February 2021 to March 2023.The severity of ACI patients was evaluated based on their National Institutes of Health Stroke Scale(NIHSS)scores,and they were divided into mild group(26 cases,NIHSS scores 0-15),moderate group(32 cases,NIHSS scores 16-30),and severe group(22 cases,NIHSS scores 31-45);And 30 healthy individuals who underwent physical examinations during the same period were selected as the control group.The improved Rankin Scale(MRS)was used to evaluate the prognosis of patients,who were divided into a good prognosis group(59 cases)and a poor prognosis group(21 cases)based on the scoring results.All patients underwent dynamic electrocardiogram examination,and the heart rate variability parameters of each group were compared[standard deviation of R-R interval for all sinus beats at 24 hours(SDNN),mean standard deviation of R-R interval for 5 consecutive minutes at 24 hours(SDNN Index),standard deviation of R-R interval mean every 5 minutes(SDANN),root mean square of all adjacent R-R interval differences(rMSSD),and the proportion of adjacent NN interval differences greater than 50 ms(PNN50%)].The predictive value of heart rate variability parameters on the severity and prognosis of ACI patients was analyzed using receiver operating characteristic(ROC)curves.Logistic regression analysis was used to identify the risk factors for the severity and prognosis of ACI patients.Results The SDNN,SDANN,SDNN Index,rMSSD,and PNN50%of the mild,moderate,and severe groups were significantly lower than those of the control group(F=59.382,11.859,12.376,11.699,47.703,all P<0.01),and the severe group was less than the moderate group and less than the mild group(all P<0.05).The SDNN,SDANN,SDNN Index,rMSSD,and PNN50%in the poor prognosis group were lower than those in the good prognosis group(t=4.536,4.181,5.091,4.384,2.851,all P<0.01).The results of logistic regression analysis showed that heart rate variability parameter was an independent influencing factor for the severity and poor prognosis of ACI patients(all P<0.01).The area under the curve for the combined diagnosis of the severity of ACI patients using SDNN,SDANN,SDNN Index,rMSSD,and PNN50%was 0.950,and the area under the curve for the combined prediction of ACI patients′prognosis was 0.970.Conclusions The heart rate variability parameter is an independent influencing factor on the severity and prognosis of ACI patients,and its predictive power for the severity and prognosis of ACI patients is high.It can be used as an effective indicator for evaluating the severity and prognosis of ACI patients.