慢性充血性心力衰竭患者窦性心率震荡的检测及其临床价值

Detecting and Clinical Value of Sinus Arrhythmia in Chronic Congestive Heart Failure Patients

目的探讨心率震荡现象在慢性充血性心衰(CHF)患者中的诊治价值及其临床意义。方法选择慢性充血性心力衰竭患者79例,正常对照组26例。CHF患者通过24 h动态心电图检测心率震荡的两个参数:震荡初始(TO)和震荡斜率(TS),同时检测血浆脑钠肽的浓度、超声心动图测定左室射血分数(LVEF)及左室舒张末期内径(LVEDD)。结果与对照组相比,心力衰竭组患者LVEF下降、LVEDD增加、BNP升高、TO值升高、TS值减低(P均<0.05);心力衰竭患者的TO、血浆BNP值随着心功能分级的增加而增高,TS值及LVEF随着心功能分级增加而降低(P均<0.01)。心衰组各分级患者TO、TS、血浆BNP值均高于对照组(P<0.05);心衰组TS、TO异常患者的LVEF值较正常者明显减低、BNP值显著增高(P<0.05)。CHF患者TO与LVEDD、BNP呈正相关(P<0.05),与LVEF呈负相关;TS与LVEDD、LVEF及BNP呈负相关(P<0.05)。结论慢性充血性心衰患者的窦性心率震荡参数与BNP、心功能相关指标存在良好的相关性,因此窦性心率震荡可做为评价心衰预后的指标。

Objective To investigate the expression of heart rate turbulence and its clinical significance in patients with chronic congestive heart failure( CHF) patients. Methods 79 caseswith chronic congestive heart failure were chosen,which includ normal control group of 26 cases. Two parameters were detected 24 h Holter heart rate turbulence in CHF patients: turbulence onset( TO) and turbulence slope( TS),while detecting the concentration of plasma brain natriuretic peptide,echocardiographic left ventricular ejection fraction( LVEF)and left ventricular diastolic Nei Jing( LVEDD). Results Compared with normal control group,heart failure patients LVEF declined,LVEDD increased,BNP increased,TO increased,TS reduced( P < 0. 05). Heart failure patients TO and plasma BNP increased with cardiac function increasing while TS and LVEF increased with NYHA classification decreasing( P < 0. 01). classification TO,TS,plasma BNP Each group of patients with heart failure were higher significantly than that in controls( P < 0. 05). TS,TO in patients with abnormal LVEF was significantly lower than those of normals while BNP in patients with abnormal LVEF was significantly higher than those of normals( P < 0. 05). TO of CHF patients was positively correlated significantly with LVEDD,BNP( P < 0. 05) while it was negatively significantly correlated with LVEF. TS and LVEDD,LVEF and BNP was negatively significantly correlated( P < 0. 05). Conclusion Heart rate turbulence parameters in patients with chronic congestive heart failure were correlated with BNP and cardiac function. Therefore,sinus heart rate turbulence may be an indicator for evaluating the prognosis of heart failure.