【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个月内更多还原

【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.更多还原