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病毒性心肌炎患者病程中心脏自主神经功能与心律失常关系的动态研究

Relationship between automatic nervous function and arrhythmia in patients with acute viral myocarditis

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【作者】 高修仁曾群英李树彬谢耀群张焰

【Author】 Gao Xiuren,Zeng Qunying,Li Shubin,et al. epartment of Cardiology Heart Center of First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080,China

【机构】 中山大学附属第一医院心血管内科中山大学附属第一医院心血管内科 (510080)(510080)(510080)

【摘要】 目的 :探讨病毒性心肌炎患者病程中心脏自主神经功能与心率变异性 (heartratevariability ,HRV)、心律失常发生率的动态关系。方法 :测定 96例急性病毒心肌炎在病程不同阶段 (1、 3、 6个月 )的心脏自主神经功能 ,同时通过动态心电图分析HRV以及各种心律失常的发生情况。结果 :①病毒性心肌炎患者病程第 1个月内自主神经功能检查有 1项或 1项以上异常者占 5 8% (5 6 /96 ) ,到 6个月时 ,仅占17% ,前后比较P <0 0 1;②HRV时域法分析以 2 4小时内 5分钟节段正常R R间期标准差的平均数及连续正常R R间期之差的均方根值在疾病初期 (1个月时 )明显减少 ,随着时间推移逐渐恢复 ,到 6个月时与 1个月比较P <0 0 1,HRV能谱分析在疾病初期总能谱、低能谱及高能谱均减低 ,6个月时增高 ,前后比较总能谱、低能谱均为P <0 0 1,高能谱为P <0 0 5 ;③按自主神经功能检查结果阳性与阴性分为两组 ,疾病初期阳性组的窦性心动过速、频发室性期前收缩、二联律、成对室性期前收缩及短阵室性心动过速的发生率均高于阴性组 (均为P <0 0 5 ) ;6个月时随着心脏自主神经功能及HRV的恢复两组差异均无统计学意义 ,与 1个月时比较各种心律失常的发生率明显减少 (均为P <0 0 5 )。结论 :①急性病毒性心肌炎患者疾病早期 (1个月内

【Abstract】 Objective: To study the relationship among automatic nervous function(ANF), heart rate variability (HRV) and the incidence of arrhythmia in patients of acute viral myocarditis. Methods:Measurement of ANF was performed in 96 consecutive patients with acute viral myocarditis in different stage of the disease(1, 3 or 6 months). HRV and arrhythmia were monitored by Holter EKG monitoring. Results:①58%(56/96) of patients showed at least one abnormal ANF tests and the incidence was significantly reduced to 17% after 6 months(P<0.01). ② The rMSSD and PNN50 by time domain analysis of heart rate variability were significantly reduced in the early stage of the disease and recovered by 6 months(P<0.05). The total frequency (TF), low frequency (LF) and high frequency (HF) power spectral components were significantly reduced in early stage and recovered by 6 months(P<0.05). ③The incidence of sinus tachycardial, frequency ventricular ectopy, ventricular ectopy bigemina and short run ventricular tachycardial in patients with abnormal ANF was significantly higher than patients with normal ANF function(P<0.05). The incidence of arrhythmia in patients with abnormal ANF at 6 month was significantly lower than that of the first month(P<0.05), but was not significantly different from that of patients with normal ANF by 6 months.Conclusions:① There is significant impairment of autonomic nervous function in the early stage of acute viral myocarditis with lower rMSSD, PNN50, TF, LF, HF and higher incidence of various arrhythmia. ②Autonomic nervous function and HRV abnormality significantly improve and the incidence of arrhythmia is significantly reduced by 6 months. Cardiac electricity is unstable in early stage(within 6 months) of viral myocarditis. Restriction of exercise, adequate rest and proper treatment are important for prevention of arrhythmia. It would be safe after 6 months if no viral reinfection occurs.

  • 【分类号】R542.21
  • 【被引频次】5
  • 【下载频次】96
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