心率变异性降低的临床价值

Clinical value of heart rate variability decrease

目的了解心率变异性降低对住院患者病情评估和预后判断的临床价值。方法分析心率变异性正常37例(A组)、中度降低47例(B组)、重度降低43例(C组)住院患者的动态心电图资料和临床诊断、病情及转归情况。结果三组患者心率变异性5项时域指标在A、B、C组间逐渐降低(P<0.01);24 h最快心率差异无统计学意义(P>0.05);24 h最慢心率和平均心率在A、B、C组间逐渐升高(P<0.01)。临床资料显示三组患者中危重病例比例、在院死亡比例逐渐升高(P<0.01),A组为5.4%和2.7%,B组为17.0%和6.4%,C组为60.5%和27.9%;心率变异性降低与危重病例和在院死亡均存在相关性,相关系数分别为0.492和0.307(P均<0.01)。结论心率变异性检测稳定性和重复性好,心率变异性降低程度可以作为患者病情危重和预后不良的预测指标。

Objective To explore the clinical value of heart rate variability( HRV) decrease for condition evaluation and prognosis judgement of inpatients. Methods The ambulatory electrocardiography data,clinical diagnosis,conditions and prognosis were analyzed on 37 cases with normal HRV( group A),47 cases with moderately decreased HRV( group B),and 43 cases with severely decreased HRV( group C). Results Among the three groups,the five time domain indexes of HRV gradually reduced from group A to group C( P < 0. 01). The difference of the highest heart rate within 24 hours was not statistically significant( P > 0. 05) while the lowest heart rate and the average heart rate within 24 hours gradually increased from group A to group C( P < 0. 01). It revealed by clinical data that there was a significant raise gradually from group A to group C in the proportions of severe cases and death in hospital( P < 0. 01). The proportions were 5. 4% and2. 7% in group A,17. 0% and 6. 4% in group B,and 60. 5% and 27. 9% in group C,respectively. The decrease of HRV was correlated to both the proportion of severe cases and that of death in hospital( r = 0. 4927 vs. 0. 307; P < 0. 01). Conclusion The HRV check is superior in stability and repeatability. The degree of HRV decrease can be utilized as an predictor of the severity and unfavourable prognosis of patients.