同步心率、血压变异性与冠状动脉病变的相关性
동보심솔、혈압변이성여관상동맥병변적상관성
The correlation between synchronic variation of heart rate and blood pressure and coronary artery leslons
  • 万方数据
    中国医师进修杂志 중국의사진수잡지
    CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
    2012年 22期 13-16 ,共4页

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    冠状动脉疾病%心率变异性%时域指标%血压变异性%血压标准差 冠狀動脈疾病%心率變異性%時域指標%血壓變異性%血壓標準差
    관상동맥질병%심솔변이성%시역지표%혈압변이성%혈압표준차
    Coronary disease%Heart rate variability%Time domain indexes%Blood pressure variability%Blood pressure standard deviation
    目的 探讨同步心率变异性(HRV)、血压变异性(BPV)在评估冠心病病情中的意义.方法 103例行冠状动脉造影患者按冠状动脉病变程度分为闭塞组(至少1支冠状动脉完全闭塞)28例,非闭塞组(至少1支冠状动脉狭窄≥50％但未完全闭塞)45例,对照组(未见有意义的≥50％狭窄)30例.其中闭塞组和非闭塞组患者按病变部位分为左前降支(LAD)病变为主32例、左回旋支(LCX)病变为主23例、右冠状动脉(RCA)病变为主18例；按病变支数分为1支病变23例,2支病变19例,3支病变31例.通过同步24h动态血压／心电记录分析仪检查计算HRV的各时域指标,包括R-R间期总体标准差(SDNN)、24h每5min时段平均正常R-R间期标准差(SDANNind)、每5 min时段正常R-R间期标准差的24h平均值(SDNNind)、相邻正常R-R间期差值的均方根(rMSSD)、相邻正常R-R间期差值＞50 ms的百分数(PNNso),并检测BPV指标,包括白昼收缩压变异(dSSD)、白昼舒张压变异(dDSD)、夜间收缩压变异(nSSD).分析同步HRV、BPV与不同冠状动脉病变之间的相关性.结果 随冠状动脉狭窄程度加重,SDNN、SDANNind明显降低,dSSD明显升高,差异有统计学意义[(115±35) ms比(98±25) ms比(78±28) ms,(100±30) ms比(86±23)ms比(70±29) ms,(14±3)mm Hg(l mm Hg=0.133 kPa)比(20±4) mm Hg比(28±2)mm Hg](P＜0.05).随冠状动脉狭窄程度加重,rMSSD、PNN50减低,dDSD、nSSD升高,但差异无统计学意义(P＞0.05).LAD病变为主和LCX病变为主患者SDNN、SDANNind显著低于对照组,dSSD显著高于对照组,差异有统计学意义(P＜0.01或＜0.05).LAD病变为主和LCX病变为主患者SDNNind、rMSSD、PNN50、dDSD、nSSD与对照组比较差异无统计学意义(P＞0.05).而RCA病变为主患者SDNN、SDANNind、SDNNind、rMSSD、PNN50、dSSD、dDSD、nSSD与对照组比较差异均无统计学意义(P＞0.05).随冠状动脉病变支数增加,HRV各指标逐渐下降,BPV各指标逐渐升高,但只有SDNN、SDANNind、SDNNind、rMSSD、PNN50、dSSD变化差异有统计学意义(P＜0.05).结论 冠心病患者HRV下降越明显且dSSD升高越明显,提示冠状动脉狭窄程度越重,病变多在左冠状动脉、病变范围越广.对冠心病患者病情评估具有一定的指导意义.
    목적 탐토동보심솔변이성(HRV)、혈압변이성(BPV)재평고관심병병정중적의의.방법 103례행관상동맥조영환자안관상동맥병변정도분위폐새조(지소1지관상동맥완전폐새)28례,비폐새조(지소1지관상동맥협착≥50％단미완전폐새)45례,대조조(미견유의의적≥50％협착)30례.기중폐새조화비폐새조환자안병변부위분위좌전강지(LAD)병변위주32례、좌회선지(LCX)병변위주23례、우관상동맥(RCA)병변위주18례；안병변지수분위1지병변23례,2지병변19례,3지병변31례.통과동보24h동태혈압／심전기록분석의검사계산HRV적각시역지표,포괄R-R간기총체표준차(SDNN)、24h매5min시단평균정상R-R간기표준차(SDANNind)、매5 min시단정상R-R간기표준차적24h평균치(SDNNind)、상린정상R-R간기차치적균방근(rMSSD)、상린정상R-R간기차치＞50 ms적백분수(PNNso),병검측BPV지표,포괄백주수축압변이(dSSD)、백주서장압변이(dDSD)、야간수축압변이(nSSD).분석동보HRV、BPV여불동관상동맥병변지간적상관성.결과 수관상동맥협착정도가중,SDNN、SDANNind명현강저,dSSD명현승고,차이유통계학의의[(115±35) ms비(98±25) ms비(78±28) ms,(100±30) ms비(86±23)ms비(70±29) ms,(14±3)mm Hg(l mm Hg=0.133 kPa)비(20±4) mm Hg비(28±2)mm Hg](P＜0.05).수관상동맥협착정도가중,rMSSD、PNN50감저,dDSD、nSSD승고,단차이무통계학의의(P＞0.05).LAD병변위주화LCX병변위주환자SDNN、SDANNind현저저우대조조,dSSD현저고우대조조,차이유통계학의의(P＜0.01혹＜0.05).LAD병변위주화LCX병변위주환자SDNNind、rMSSD、PNN50、dDSD、nSSD여대조조비교차이무통계학의의(P＞0.05).이RCA병변위주환자SDNN、SDANNind、SDNNind、rMSSD、PNN50、dSSD、dDSD、nSSD여대조조비교차이균무통계학의의(P＞0.05).수관상동맥병변지수증가,HRV각지표축점하강,BPV각지표축점승고,단지유SDNN、SDANNind、SDNNind、rMSSD、PNN50、dSSD변화차이유통계학의의(P＜0.05).결론 관심병환자HRV하강월명현차dSSD승고월명현,제시관상동맥협착정도월중,병변다재좌관상동맥、병변범위월엄.대관심병환자병정평고구유일정적지도의의.
    Objective To investigate the significance of synchronic heart rate variation(HRV) and blood pressure variation(BPV) in the evaluation of coronary artery disease(CAD).Methods One hundred and three patients who received coronary artery angiography were divided by the lesion degree into occlusion group (28 cases with more than 1 complete-occlusion coronary artery),non-occlusion group (45 cases with more than 1 coronary artery stenosis ≥50％ but without complete-occlusion) and control group (30 cases without stenosis ≥50％).Occlusion group and non-occlusion group were divided by lesion location into left anterior descending (LAD) lesion (32 cases),left circumflex ( LCF ) lesion (23 cases ) and right coronary artery (RCA) lesion (18 cases).And these two groups were also divided by lesion branch number into 1 lesion branch (23 cases),2 lesion branches (19 cases) and 3 lesion branches(31 cases).The time domain indexes of HRV were detected and calculated by 24 h dynamic blood pressutre and ECG,including standard deviation of normal number of R-R intervals (SDNN),standard deviation of per 5 min average normal R-R intervals(SDANNind),24 h average of standard deviation of per 5 min normal R-R intervals(SDNNind),root mean square of standard deviation of adjacent normal R-R intervals (rMSSD),and percentage of the difference of adjacent normal R-R intervals ＞ 50 ms (PNN50).And indexes of BPV were detected,including daytime systolic pressure standard deviation (dSSD),daytime diastolic pressure standard deviation (dDSD) and nighttime systolic blood pressure standard deviation (nSSD).The correlations between synchronic HRV and BPV and different coronary artery lesions were analyzed.Results SDNN,SDANNind significantly decreased and dSSD obviously increased with the aggravation of coronary stenosis,and there was statistical significance[ ( 115 ± 35 ) ms vs.(98 ± 25 ) ms vs.( 78 ± 28 ) ms,( 100 ± 30) ms vs.( 86 ± 23 ) ms vs.( 70 ± 29 )ms,(14 ± 3) mm Hg (1 mm Hg=0.133 kPa) vs.(20±4) mm Hg vs.(28±2) mm Hg](P＜0.05).rMSSD and PNN50 decreased,dDSD and nSSD increased with the aggravation of coronary artery stenosis,but there was no statistical significance (P＞0.05).SDNN and SDANNind in patients with LAD lesion and LCX lesion were significantly lower than those in control group,and dSSD was obviously higher than that in control group (P ＜ 0.01 or ＜ 0.05 ).SDANNind,rMSSD,PNN50,dDSD and nSSD in patients with LAD lesion and LCX lesion had no significant difference compared with those in control group (P ＞ 0.05 ).SDNN,SDANNind,SDNNind,rMSSD,PNN50,dSSD,dDSD and nSSD in patients with RCA lesion had no statistical significance compared with those in control group ( P ＞ 0.05 ).All the indexes of HRV tended to descend and indexes of BPV trended to raise with the increasing number of coronary artery lesion branches.But only the changes of SDNN,SDANNind,SDNNind,rMSSD,PNN50 and dSSD had statistical significance (P ＜ 0.05).Conclusions The more significantly HRV decreases and dSSD increases in patients with coronary artery disease,the more serious the coronary artery stenosis is and the wider the lesions are.The lesions are commonly located in LAD.It has certain guiding value for the evaluation of coronary artery diseases.
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