中华危重症医学杂志（电子版）
中華危重癥醫學雜誌（電子版）
중화위중증의학잡지（전자판）
CHINESE JOURNAL OF CRITICAL CARE MEDICINE ( ELECTRONIC EDITON)
2015年
1期
12-16
,共5页
心率减速力%心力衰竭%预后
心率減速力%心力衰竭%預後
심솔감속력%심력쇠갈%예후
Deceleration capacity of rate%Heart failure%Prognosis
目的：评估心率减速力（DC）对慢性心力衰竭（CHF）患者心力衰竭严重程度的影响及近期预后中的价值。方法选择2012年10月至2013年5月期间心内科住院确诊为CHF的患者80例为CHF组，同期年龄、性别相匹配的健康体检者76例为对照组。所有入选者经动态心电图获取DC、平均心率参数。同时行心脏彩色多普勒超声检查，测定左室舒张末期内径（LVEDd）与左室射血分数（LVEF）。同时将CHF组患者按纽约心脏病学会心功能分级标准分组。比较CHF组与对照组的DC、平均心率参数，同时比较CHF患者各亚组间DC、LVEDd及LVEF值的差异，并研究CHF患者的DC与LVEDd及LVEF值之间的线性关系。将CHF患者根据DC值分成低危组、中危组及高危组，通过随访CHF患者6～12个月，进一步分析不同DC水平对CHF预后的影响。结果与对照组比较，CHF组DC值减少，平均心率增快（t＝2.28、2.24，P均<0.05）。随着心功能的下降，CHF患者的DC、LVEF值逐渐减少，LVEDd值逐渐升高（F＝9.01、4.89、42.45，P均<0.05），且CHF患者DC值与LVEF呈正相关（r＝0.19，P<0.05），而与LVEDd无明显相关性（r＝0.67，P>0.05）。随访结果发现，高危组患者心源性猝死，恶性室性心律失常及反复心力衰竭发作再住院的发生率明显高于低中危组（χ2＝5.08、7.65、6.08，P均<0.05）。结论CHF患者血清DC值明显降低，且随着心功能的恶化而下降，DC值不仅能反映心力衰竭的严重程度，而且可作为评估近期预后的指标。
目的：評估心率減速力（DC）對慢性心力衰竭（CHF）患者心力衰竭嚴重程度的影響及近期預後中的價值。方法選擇2012年10月至2013年5月期間心內科住院確診為CHF的患者80例為CHF組，同期年齡、性彆相匹配的健康體檢者76例為對照組。所有入選者經動態心電圖穫取DC、平均心率參數。同時行心髒綵色多普勒超聲檢查，測定左室舒張末期內徑（LVEDd）與左室射血分數（LVEF）。同時將CHF組患者按紐約心髒病學會心功能分級標準分組。比較CHF組與對照組的DC、平均心率參數，同時比較CHF患者各亞組間DC、LVEDd及LVEF值的差異，併研究CHF患者的DC與LVEDd及LVEF值之間的線性關繫。將CHF患者根據DC值分成低危組、中危組及高危組，通過隨訪CHF患者6～12箇月，進一步分析不同DC水平對CHF預後的影響。結果與對照組比較，CHF組DC值減少，平均心率增快（t＝2.28、2.24，P均<0.05）。隨著心功能的下降，CHF患者的DC、LVEF值逐漸減少，LVEDd值逐漸升高（F＝9.01、4.89、42.45，P均<0.05），且CHF患者DC值與LVEF呈正相關（r＝0.19，P<0.05），而與LVEDd無明顯相關性（r＝0.67，P>0.05）。隨訪結果髮現，高危組患者心源性猝死，噁性室性心律失常及反複心力衰竭髮作再住院的髮生率明顯高于低中危組（χ2＝5.08、7.65、6.08，P均<0.05）。結論CHF患者血清DC值明顯降低，且隨著心功能的噁化而下降，DC值不僅能反映心力衰竭的嚴重程度，而且可作為評估近期預後的指標。
목적：평고심솔감속력（DC）대만성심력쇠갈（CHF）환자심력쇠갈엄중정도적영향급근기예후중적개치。방법선택2012년10월지2013년5월기간심내과주원학진위CHF적환자80례위CHF조，동기년령、성별상필배적건강체검자76례위대조조。소유입선자경동태심전도획취DC、평균심솔삼수。동시행심장채색다보륵초성검사，측정좌실서장말기내경（LVEDd）여좌실사혈분수（LVEF）。동시장CHF조환자안뉴약심장병학회심공능분급표준분조。비교CHF조여대조조적DC、평균심솔삼수，동시비교CHF환자각아조간DC、LVEDd급LVEF치적차이，병연구CHF환자적DC여LVEDd급LVEF치지간적선성관계。장CHF환자근거DC치분성저위조、중위조급고위조，통과수방CHF환자6～12개월，진일보분석불동DC수평대CHF예후적영향。결과여대조조비교，CHF조DC치감소，평균심솔증쾌（t＝2.28、2.24，P균<0.05）。수착심공능적하강，CHF환자적DC、LVEF치축점감소，LVEDd치축점승고（F＝9.01、4.89、42.45，P균<0.05），차CHF환자DC치여LVEF정정상관（r＝0.19，P<0.05），이여LVEDd무명현상관성（r＝0.67，P>0.05）。수방결과발현，고위조환자심원성졸사，악성실성심률실상급반복심력쇠갈발작재주원적발생솔명현고우저중위조（χ2＝5.08、7.65、6.08，P균<0.05）。결론CHF환자혈청DC치명현강저，차수착심공능적악화이하강，DC치불부능반영심력쇠갈적엄중정도，이차가작위평고근기예후적지표。
Objective To assess the deceleration capacity (DC) rate for the severity and short-term prognosis in patients with chronic heart failure (CHF). Methods Eighty CHF patients in the First Affiliated Hospital of Wenzhou Medical University from October 2012 to May 2013 were enrolled as the CHF group, and the same period of age, gender matched seventy-six healthy cases served as the control group. The levels of DC and average heart rate parameter were detected by dynamic electrocardiogram, and the left ventricular end-diastolic diameter (LVEDd) and left ventricular ejection fraction (LVEF) were measured by echocardiography. According to the NewYork Heart Association classification, CHF patients were divided into the classⅡgroup (26 cases), classⅢgroup (28 cases) and classⅣgroup (26 cases), and DC LVEDd and LVEF were compared between the CHF subgroups. The levels of DC and average heart rate parameter were compared between the CHF group and control group. Pearsonˊs method was employed to analyze the DC, LVEDd and LVEF. CHF patients were followed up for 6-12 months. The cardiac death, malignant ventricular arrhythmia, cardiac shock and re-hospitalization due to heart failure were further analyzed according to the different DC values in the CHF patients (low, intermediate and high risk groups). Results Compared with the control group, DC value decreased and average heart rate increased in the CHF group (t=2.28, 2.24; all P<0.05). With the decrease of cardiac function, the value of DC and LVEF taper off and the value of LVEDd increased gradually (F=9.01, 4.89, 42.45; all P<0.05). Positive correlation between DC and LVEF was observed in CHF patients (r=0.19, P<0.05), but there was no statistical correlation between DC and LVEDd (r = 0.67, P > 0.05). The incidence of cardiac death, malignant ventricular arrhythmia and re-hospitalization due to heart failure in the high-risk group were higher than those in the low and intermediate risk groups (χ2=5.08, 7.65, 6.08; all P<0.05). Conclusions The values of DC in CHF patients decreased significantly, and the DC values gradually decreased with the decrease of heart function. The value of DC can not only reflect the severity of heart failure, but also evaluate the prognosis of CHF patients.
