CAJ | 학술논문

目的：观察急性心肌梗死（AMI）患者心率变异性（HRV）的变化，分析减慢呼吸频率对 AMI 患者 HRV 的影响。方法试验分两组，AMI 组31例，对照组34例，行24 h 心电呼吸监测；AMI 组行5 min 16次／min 及减慢呼吸频率（8次／min）的呼吸调节。观察 AMI 对 HRV的影响，减慢呼吸频率对 HRV 时域、呼吸峰及频域分析的影响，并校正呼吸峰移位对频域分析的影响。结果（1）AMI 组 SDNN、SDANN 较对照组降低（P ＜0．01），SDNNin、rMSSD 降低（P ＜0．05），差异均有统计学意义；其中 AMI 组 SDNN ＜100 ms 的比例明显高于对照组（P ＜0．01），差异有统计学意义。（2）①减慢呼吸频率 SDNN 升高（P ＞0．05），rMSSD 升高（P ＜0．05）；呼吸峰左移至 LF 段（P ＜0．01），常规频域指标 LF 及 LF ／HF 升高（P ＜0．01），HF降低（P ＜0．01）；②校正减慢呼吸频率引起呼吸峰左移对频域分析的影响后，低频成分（LFa）降低（P ＜0．05），高频成分（HFa）升高（P ＜0．01），低高频比值（LFa ／HFa）降低（P ＜0．01）。结论AMI 24 h HRV 时域分析提示 AMI 可降低迷走神经兴奋性，AMI 短时程频域及时域分析提示减慢呼吸频率使交感-迷走平衡移向迷走神经。在 HRV 频域分析中必须排除减慢呼吸频率对呼吸峰左移的影响。
목적：관찰급성심기경사（AMI）환자심솔변이성（HRV）적변화，분석감만호흡빈솔대 AMI 환자 HRV 적영향。방법시험분량조，AMI 조31례，대조조34례，행24 h 심전호흡감측；AMI 조행5 min 16차／min 급감만호흡빈솔（8차／min）적호흡조절。관찰 AMI 대 HRV적영향，감만호흡빈솔대 HRV 시역、호흡봉급빈역분석적영향，병교정호흡봉이위대빈역분석적영향。결과（1）AMI 조 SDNN、SDANN 교대조조강저（P ＜0．01），SDNNin、rMSSD 강저（P ＜0．05），차이균유통계학의의；기중 AMI 조 SDNN ＜100 ms 적비례명현고우대조조（P ＜0．01），차이유통계학의의。（2）①감만호흡빈솔 SDNN 승고（P ＞0．05），rMSSD 승고（P ＜0．05）；호흡봉좌이지 LF 단（P ＜0．01），상규빈역지표 LF 급 LF ／HF 승고（P ＜0．01），HF강저（P ＜0．01）；②교정감만호흡빈솔인기호흡봉좌이대빈역분석적영향후，저빈성분（LFa）강저（P ＜0．05），고빈성분（HFa）승고（P ＜0．01），저고빈비치（LFa ／HFa）강저（P ＜0．01）。결론AMI 24 h HRV 시역분석제시 AMI 가강저미주신경흥강성，AMI 단시정빈역급시역분석제시감만호흡빈솔사교감-미주평형이향미주신경。재 HRV 빈역분석중필수배제감만호흡빈솔대호흡봉좌이적영향。
Objective To observe the changes of heart rate variability(HRV)in patients with acute myocardial infarction(AMI),and to analyze the influence of slowing breathing frequency on HRV of AMI patients.Methods Experiment was carried out in two groups,with 31 cases in AMI group,and 34 in control group.All the enrolled patients underwent 24-hour monitoring of respiration and electrocardiogram.The breathing frequency of AMI group was regulated at 16 times/min and 8 times/min(slowing the breathing frequency)separately for 5 minutes.The influence of AMI on HRV was observed as well as the slowing of breathing frequency on HRV time domain,respiratory peak,and frequency domain analysis.The influence of respiratory peak shift on frequency domain <br> analysis was adjusted.Results (i)In AMI group,SDNN and SDANN were lower than those of con-trol group(P <0.01 ),and so were SDNNin and rMSSD(P <0.05),both with statistically significant differences.The proportion among AMI group with SDNN shorter than 100 ms was significantly higher than that in control group(P <0.01 ),with statistically significant difference.(ii)With the slowing of breathing frequency,SDNN increased(P >0.05),and rMSSD also increased(P <0.05);respiratory peak shifted left to LF segment(P <0.01 )while routine frequency domain indices of LF and LF /HF both increased(P <0.01 ),and HF decreased(P <0.01 ).The slowing of breathing frequency resul-ted in the left shift of respiratory peak.After its impact on frequency domain analysis was corrected, low-frequency component(LFa)decreased(P <0.05),high-frequency component(HFa)increased (P <0.01 ),and the ratio(LFa/HFa)decreased(P <0.01 ).Conclusion Twenty-four-hour HRV time domain analysis on AMI patients indicates that AMI can reduce the function of vagus nerve.Short duration analysis of frequency and time domain on AMI patients suggests that slowing of breathing frequency causes sympathetic-vagal balance toward the vagus nerve and its influence on the left shift of respiratory peak should be excluded in HRV frequency domain analysis.