冠心病合并慢性心力衰竭患者窦性心率震荡的研究

目的研究窦性心率震荡（heart rate turbulence,HRT）在冠心病合并慢性心力衰竭患者中的变化,并探讨其临床价值。方法选择冠心病患者50例（A组）、冠心病并慢性心力衰竭患者50例（B组）、正常健康对照者50例（对照组）。根据24 h动态心电图（Holter）的记录资料,计算HRT的2个参数震荡初始（turbulence onset,TO）和震荡斜率（turbulence slope,TS）,通过心脏彩色多普勒超声测定、评估慢性心力衰竭的常用指标左室射血分数（LVEF）、左室舒张末期内径（LVEDD）,比较各组之间的TO、TS、LVEF、LVEDD的差别。结果 A组TO值、LVEDD值高于对照组（P〈0.05）,而TS、LVEF值低于对照组（P〈0.05）;B组TO值、LVEDD值显著高于对照组（P〈0.01）,而TS值、LVEF值显著低于对照组（P〈0.01）;B组TO值、LVEDD值高于A组（P〈0.05）,而TS值、LVEF值低于A组（P〈0.05）。结论冠心病患者HRT现象减弱,而冠心病合并慢性心力衰竭患者HRT现象减弱更明显。HRT可能成为评价冠心病合并慢性心力衰竭患者自主神经功能状态、预测其危险程度的新指标。

Heart Rate Turbulence in Patients with Coronary Heart Disease and Chronic Congestive Heart Failure

Objective To study the changes in heart rate turbulence（HRT） in patients with coronary heart disease and chronic congestive heart failure,and to explore its clinical value.Methods Fifty patients with coronary heart disease（group A）,50 patients with coronary heart disease and chronic congestive heart failure（group B）,and 50 healthy persons（control group） were enrolled and were monitored with a 24 h digital Holter recorder,and turbulence onset（TO）and turbulence slope（TS） were calculated.Two indexes of heart functional assessment,-including left ventricular ejection fraction（LVEF）and left ventricular end-diastolic diameter（LVEDD）,were determined by ultrasonic cardiograph.The differences in TO,TS,LVEF and LVEDD among the groups were compared.Results TO and LVEDD in group A or group B were significantly higher than those in control group（P〈0.05 or P〈0.01）,while TS and LVEF were obviously lower than those in control group（P〈0.05 or P〈0.01）.TO and LVEDD in group B were higher than those in group A（P〈0.05）,while TS and LVEF in group B were lower than those in group A（P〈0.05）.Conclusion There is a decrease of HRT in patients with coronary heart disease and a significant decrease in patients with coronary heart disease and chronic congestive heart failure.HRT may be a new indicator to assess the functional status of autonomic nervous system and to predict the danger in the patients with coronary heart disease and chronic congestive heart failure.