【作者】 刘杰；

【导师】 张煜；

【作者基本信息】 吉林大学 ， 临床医学， 2005， 硕士

【摘要】 目的:探讨心力衰竭患者的心率变异性(HRV)及其昼夜节律变化,以及应用螺内酯治疗后对HRV 及其昼夜节律的影响。方法:对24 例充血性心力衰竭(CHF)的病例(分为NYHA 心功能≥Ⅲ级组14 人和心功能Ⅱ级组10 人)与10 例正常组对照研究,并将心功能≥Ⅲ级组的14 人随机分为应用螺内酯的治疗组7 人及应用安慰剂组7 人(此组仅用双氢克脲噻或速尿利尿治疗)。对正常对照组及所有入选患者进行48 小时动态心电图检测,对心功能≥Ⅲ级组的患者进行4 周的治疗之后复查动态心电,比较两组HRV 各指标的差别。采用Holter48 小时全信息心电记录,计算机分析系统对HRV 频域指标(LF、HF)及时域指标(NN、SDNN、SDANN、RMSSD、PNN50)进行分析。结果:1.随着心功能的下降,HRV 时域及频域各指标逐渐下降,心功能Ⅱ级组HF 突然下降,与正常心功能组对比差异有显著性(P<0.01),与心功能≥Ⅲ级组对比差异无显著性(P>0.05)。心功能Ⅱ级组NN 及SDNN、SDANN、RMSSD、PNN50 也下降(除SDANN 达到统计学意义P<0.05 外,其余仅有下降趋势无统计学意义),但心功能≥Ⅲ级组则下降更明显(P<0.01)。2.心功能≥Ⅲ级组HRV 各能谱范围消失,无昼夜节律性,其中LF、HF、NN 表现最为显著,但心功能Ⅱ级组的昼夜节律存在。3.应用螺内酯治疗组的HRV 各项指标均增高,特别是HF 和NN 与安慰剂组比较增高更显著,且在早晨6-10 点这种改变最显著。结论:心率变异性测定可作为心力衰竭的诊断更多还原

【Abstract】 Objective: Sprionolactone therapy can improve the survival in CHF, but the mechanism of its benefit is uncertain. Experimental evidence suggests that aldosterone may have detrimental effects on the autonomic nervous system, especially during the morning hours. The study was designed to explore the circadian rhythm of time domine and frequency domine measures of HRV in heart failure, and to evalulate the circadian effects of aldosterone blockade on autonomic tong in chronic heart failure (CHF).Methods: Fourty-eight-hour HRV in the time domine and frequency domine were analyzed in twenty-four patients with New York Heart Association class Ⅱto IV CHF and ten normal people. All these 34 people were divided into three groups: (1) Normal group; (2) NYHA heart function Ⅱclass group; (3) NYHA heart function≥ Ⅲclass group which was divided into two small groups: (1) Therapy group received spironolactone 40 mg daily; (2) Placebo group for four weeks each. After treatment phase, a full circadian assessment was undertaken of spironolactone,s autonomic effect.Results: 1. The time domine and frequency domine measures ofHRV declined gradually according to the severity of heart failure. Thehigh frequency power spectral component declined sharply in patientswith class Ⅱheart function compared with the controls (p<0.01), butthere was no significant difference between the two heart failuregroups (p>0.05). 2. Disappearance of the circadian rhythm in terms of更多还原