冠心病患者心率变异性与室性心律失常的关系

Relationship between Heart Rate Variability and Ventricular Arrhythmia in Patients with Coronary Heart Disease

目的 探讨冠心病患者心律变异性 (HRV )与室性心率失常之间的关系。方法 对 88例冠心病患者 ,根据动态心电图上室性早搏 (室早 )频次分为冠心病频发室早组 ( 4 2例 )和冠心病无室早组 ( 4 6例 )进行比较 ,并分别与正常对照组( 3 0例 )进行比较 ,观察HRV的时域指标和室性心律失常。结果 冠心病患者HRV时域指标SDNN、SDANN、SDNNin dex、rMSSD和PNN50 均明显低于正常对照组 (P <0 .0 5～ 0 .0 1) ,而冠心病频发室早组除rMSSD外 ,余各项指标也明显低于冠心病无室早组 (P <0 .0 5～ 0 .0 1) ;SDNN与冠心病室性早搏频次存在明显的相关性。结论 冠心病患者HRV减低 ,反映了冠心病患者心脏自主神经调节功能失衡 ,尤其在伴有频发室早的患者中更为明显 ;冠心病室早的发生与交感神经活性增强有关 ,通过长时HRV分析 。

Objective To investigate the relationship between heart rate variability(HRV) and ventricular arrhythmia in patients with coronary heart disease.Method 88 patients with coronary heart disease were separated into two groups according to the frequency of ventricular premature beats(VPBs) in dynamic cardiogram:group with frequent VPBs(42 cases) and group without VPBs(46 cases).The two groups were compared with each other and also with the normal group(30 cases) respectively to observe their HRV indexes and ventricular arrhythmia.Results All patients showed significantly lower HRV indexes,SDNN,SDANN,SDNNindex,rMSSD and PNN 50 than the normal group(P<0.05～0.01).The group with frequent VPBs showed lower HRV indexes except rMSSD than the group without VPBs(P<0.05～0.01).There were significant correlations between SDNN index and the frequency of VPBs.Conclusions The reduced HRV in patients with coronary heart disease reflects the unbalance of regulation functions of cardiac autonomicc nerve,especially in the patients with frequent VPBs.The occurrence of VPBs in coronary heart disease is relared to the increased activity of sympathetic nerve.It could be objectively evaluated through long-time analysis on HRV.