心率变异性与慢性稳定性心绞痛分级的关系及β—受体阻滞剂的干预作用(1)
[摘要]目的 探讨心率变异性( HRV) 和慢性稳定性心绞痛(SAP)危险度分级的关系及β-受体阻滞剂的干预作用。方法 选择2015年5月～2017年5月在我院收治的门诊或住院接受治疗的慢性稳定性心绞痛的患者180例作为观察组，观察组根据加拿大心血管学会(CCS)心绞痛严重度分级；同时选取同一时期健康对照组 45 例，测定各组时域指标变化并进行对比分析。观察组随机分治疗组和對照组，分析美托洛尔对SAP患者HRV改变的干预作用。结果 CCS心绞痛严重度分级随病情加重，时域指标较对照组明显下降，且随危险度的增加HRV呈线性下降(P<0.01)；美托洛尔干预后各级SAP心率变异性显著提高(P<0.01)。美托洛尔组时域指标SDNN、SDANN、SDNNindex、rMSSD、PNN50改善明显优于对照组(P<0.05)。结论 心绞痛危险度越大HRV数值越低，HRV有可能成为预测心肌缺血和评估危险度的无创检测方法。治疗组与对照组的HRV时域指标比较，治疗组较对照组改善更为显著。
[关键词]心率变异性；慢性稳定性心绞痛；危险度；β受体阻滞剂
[中图分类号] R541 [文献标识码] A [文章编号] 1674-4721(2018)2(a)-0050-04
[Abstract] Objective To investigate the relationship between heart rate variability (HRV) and the risk grading of chronic stable angina pectoris (SAP) and the intervention effect by β-blocker.Methods 180 patients with chronic stable angina treated in our hospital from May 2015 to May 2017 were selected as the observation group.The observation group was graded according to the severity of angina pectoris of the Canadian cardiovascular society (CCS).At the same time，45 cases of healthy control group in the same period were selected， the time-domain index changes of each group were measured and compared.The observation group was randomly divided into treatment group and control group to analyze the intervention effect of metoprolol on HRV changes in sap patients.Results The severity grade of CCS angina pectoris was significantly lower than that of control group， and HRV decreased linearly with the increase of risk(P<0.01).After metoprolol intervention， the heart rate variability of sap increased significantly (P<0.01).The improvement of SDNN， SDANN， sDN nindex， rMSSD and PNN50 in metoprolol group was better than that in control group (P<0.05).Conclusion The higher the risk of angina pectoris，the lower the value of HRV.HRV may be a noninvasive method to predict myocardial ischemia and assess the risk.Compared with the control group，the HRV time-domain index of the treatment group improved more significantly than that of the control group.
[Key words]Heart rate variability；Chronic stable angina pectoris；Risk；β-blocker
心率可随着机体状况和昼夜时间而改变，这种规律性的心率变化称为心率变异性(heartrate variability HRV)[1]。HRV自从在1965年Hon和Lee[2]首先提出并应用于监测胎儿宫内窘迫心率的监护，经过几十年不断改进和发展，特别近年来新的、高频、数字化的、动态多通道心电图机的出现以及HRV相关分析程序软件的开发，HRV应用领域越来越广泛。动物实验表明[3]，心肌缺血时能兴奋心脏迷走一交感神经传入纤维，可发生多样性自主神经系统调节异常，当急性心肌缺血时，降低迷走神经张力，可伴有交感神经兴奋性增高。慢性稳定性心绞痛由于在冠状动脉狭窄基础上心肌负荷增加引起急剧的、暂时的缺血与缺氧，从而引起自主神经调节异常。虽然稳定性心绞痛患者大多数能生存很多年，但有发生急性心肌梗死或猝死的危险。当前慢性稳定性心绞痛的危险分层可根据临床评估、对负荷试验的反应、左心室功能及冠状动脉造影显示的病变情况综合判断[4]。负荷试验有一定危险性，冠状动脉造影很多基层医院未开展，探讨基层医院如何应用一种无创简单方法来评估慢性稳性心绞痛危险性分层以指导治疗是本文研究的主要目的，因此探讨慢性稳定性心绞痛严重度分级各组中HRV差异，同时分析美托洛尔对HRV的干预效果。, 百拇医药(黄祖坚)
[关键词]心率变异性；慢性稳定性心绞痛；危险度；β受体阻滞剂
[中图分类号] R541 [文献标识码] A [文章编号] 1674-4721(2018)2(a)-0050-04
[Abstract] Objective To investigate the relationship between heart rate variability (HRV) and the risk grading of chronic stable angina pectoris (SAP) and the intervention effect by β-blocker.Methods 180 patients with chronic stable angina treated in our hospital from May 2015 to May 2017 were selected as the observation group.The observation group was graded according to the severity of angina pectoris of the Canadian cardiovascular society (CCS).At the same time，45 cases of healthy control group in the same period were selected， the time-domain index changes of each group were measured and compared.The observation group was randomly divided into treatment group and control group to analyze the intervention effect of metoprolol on HRV changes in sap patients.Results The severity grade of CCS angina pectoris was significantly lower than that of control group， and HRV decreased linearly with the increase of risk(P<0.01).After metoprolol intervention， the heart rate variability of sap increased significantly (P<0.01).The improvement of SDNN， SDANN， sDN nindex， rMSSD and PNN50 in metoprolol group was better than that in control group (P<0.05).Conclusion The higher the risk of angina pectoris，the lower the value of HRV.HRV may be a noninvasive method to predict myocardial ischemia and assess the risk.Compared with the control group，the HRV time-domain index of the treatment group improved more significantly than that of the control group.
[Key words]Heart rate variability；Chronic stable angina pectoris；Risk；β-blocker
心率可随着机体状况和昼夜时间而改变，这种规律性的心率变化称为心率变异性(heartrate variability HRV)[1]。HRV自从在1965年Hon和Lee[2]首先提出并应用于监测胎儿宫内窘迫心率的监护，经过几十年不断改进和发展，特别近年来新的、高频、数字化的、动态多通道心电图机的出现以及HRV相关分析程序软件的开发，HRV应用领域越来越广泛。动物实验表明[3]，心肌缺血时能兴奋心脏迷走一交感神经传入纤维，可发生多样性自主神经系统调节异常，当急性心肌缺血时，降低迷走神经张力，可伴有交感神经兴奋性增高。慢性稳定性心绞痛由于在冠状动脉狭窄基础上心肌负荷增加引起急剧的、暂时的缺血与缺氧，从而引起自主神经调节异常。虽然稳定性心绞痛患者大多数能生存很多年，但有发生急性心肌梗死或猝死的危险。当前慢性稳定性心绞痛的危险分层可根据临床评估、对负荷试验的反应、左心室功能及冠状动脉造影显示的病变情况综合判断[4]。负荷试验有一定危险性，冠状动脉造影很多基层医院未开展，探讨基层医院如何应用一种无创简单方法来评估慢性稳性心绞痛危险性分层以指导治疗是本文研究的主要目的，因此探讨慢性稳定性心绞痛严重度分级各组中HRV差异，同时分析美托洛尔对HRV的干预效果。, 百拇医药(黄祖坚)