慢性充血性心力衰竭患者窦性心率震荡的检测和临床意义

Measurement of sinus heart rate turbulence in patients with chronic congestive heart failure and its clinical significance

【摘要】目的探讨慢性充血性心力衰竭(CHF)患者窦性心率震荡的变化特点及其与心功能的关系,并进行预后判断。方法对100例(男61例,女39例;年龄45～86岁,平均62岁)慢性充血性心力衰竭患者和50例教师体检者进行24h动态心电图检查、心脏超声、常规12导联心电图,计算出心率震荡(HRT)的参数:震荡初始值(TO)及震荡斜率值(TS),并分析两组的参数值,心脏超声测量左心室内径及射血分数。结果CHF组TO值(0.4839±0.1421)%,对照组TO值-(0.3467±0.1352)%;CHF组TS值(2.1638±0.2547)ms/RR间期,对照组TS值(6.2434±1.3589)ms/RR间期,两组比较,差异均有统计学意义。随访中发现TO、TS均异常的CHF患者的再住院率、死亡率均显著高于其他组。结论窦性心律震荡能反映压力感受器敏感性和自主神经平衡性的变化,对CHF患者的危重程度评价和预后判断有一定的参考意义。

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【Abstract】Objective To explore the clinical features of sinus heart rate turbulence (HRT) in patients with chronic congestive heart failure (CHF) and its relationship with heart function,and to discuss its prognostic significance. Methods One hundred patients (61 males and 39 females;age 45-86 years,mean 62 years) with CHF and 50 controls without structural heart diseases were enrolled. All subjects underwent 24-h Holter electrocardiogram (ECG) recordings,cardiac echocardiography,and 12-lead ECG. Two HRT parameters,turbulence onset (TO) and turbulence slope (TS) were calculated. Left ventricle interior diameter and ejection fraction (LVEF) were determined. Results TO was significantly different between CHF group and control group(0.4839±0.1421)% vs-(0.3467±0.1352)%,P<0.01,so was TS(2.1638±0.2547)ms/RR interval vs (6.2434±1.3589)ms/RR interval,P<0.01. During a follow-up of 0.5 to 2 years,both the mortality and the rehospitalization rate were higher in patients with abnormal TS and/or TO than in patients with normal TO and TS. Conclusion HRT reflects the baroreflex sensitivity and autonomic nervous system function,which has prognostic significance in CHF patients.?更多