【心率变异性与脾肾阳虚型慢性心力衰竭的相关性探讨】脾肾阳虚

　　[摘要] 目的 探讨心率变异性（HRV）与脾肾阳虚型慢性心力衰竭（CHF）的之间的关系及其意义，为脾肾阳虚型慢性心力衰竭中医证型的临床诊断，提供客观的心电图参数。 方法 将入选的120例慢性心力衰竭患者进行中医辨证分型，分为脾肾阳虚型与非脾肾阳虚型两组，并对两组患者进行24 h动态心电图检查后，实施心率变异性长程时域分析，最后将两组进行比较。 结果 脾肾阳虚型慢性心力衰竭患者HRV各项指标的平均值为：SDNN （全部正常窦性心搏间期的标准差）为（67.25±17.56）ms、SDANN（全程按5 min分成连续的时间段，先计算每5分钟的NN间期平均值，再计算所有平均值的标准差）为（56.67±14.42）ms、SDNNindex（全程按5 min分成连续的时间段，先计算每5分钟的NN间期标准差，再计算这些标准差的平均值）为（27.45±10.49）ms、rMSSD（全程相邻窦性心搏间期之差的均方根值）为（21.16±11.29）ms、pNN50（全部相邻正常RR间期之差>50 ms的个数占总窦性心搏个数的百分比）为（6.53±5.52）%，与非脾肾阳虚型组患者比较，差异有高度统计学意义（P < 0.01）。 结论 心率变异性可以作为判定脾肾阳虚型心力衰竭患者心衰严重程度、指导治疗和判定预后的参考指标之一。
　　[关键词] 心率变异性；脾肾阳虚；心力衰竭
　　[中图分类号] R541.6；R256.21 [文献标识码] A [文章编号] 1673-7210（2012）07（b）-0021-03
　　Correlation discussion of heart rate variability and yang deficiency type of spleen and kidney with chronic heart failure
　　XING Xiaobo LIU Fusong▲ ZHANG Bingyin LIU Xin FAN Guanghong
　　Department of Cardiology, the Third People"s Hospital of Qingdao City, Shandong Province, Qingdao 266041, China
　　[Abstract] Objective To investigate the possibility of heart rate variability (HRV) and yang deficiency type of spleen and kidney of chronic heart failure (CHF), provide objective electrocardiogram parameters for clinical diagnosis of yang deficiency type of spleen and kidney of symptoms and signs in traditional Chinese medicine. Methods 120 patients with CHF were analyzed with symptoms and signs in traditional Chinese medicine, who were divided into two groups of yang deficiency type of spleen and kidney and no yang deficiency type of spleen and kidney, and the heart rate variability of patients in two groups were analyzed after giving 24 h domains ambulatory electrocardiograms which were compared. Results Average levels of HRV indexes in yang deficiency type of spleen and kidney: SDNN (67.25±17.56) ms, SDANN (56.67±14.42)ms, SDNNindex (27.45±10.49)ms, rMSSD (21.16±11.29)ms, pNN50 (6.53±5.52)%, which were compared with patients with no yang deficiency type of spleen and kidney, there were significant differences (P < 0.01). Conclusion HRV can be used as a reference for the determination of the indexes for patients of yang deficiency type of spleen and kidney with chronic heart failure about heart failure severity, guide treatment and determine the prognosis.
　　[Key works] Heart rate variability; Yang deficiency type of spleen and kidney; Heart failure
　　心率变异性（heart rate variability，HRV）与心脏自主神经功能的相关性已为临床所证实，它是评估自主神经平衡性较为客观的量化指标。慢性心力衰竭（CHF）患者存在着自主神经紊乱，其自主神经的平衡性受到了损害，因而心率变异性下降，导致患者心脏性猝死（SCD）及心律失常发生率升高。本文通过观察、分析脾肾阳虚型慢性心力衰竭患者心率变异性，为脾肾阳虚型心力衰竭的中医证型的诊断，了解心衰的程度，指导治疗及病情评估、预后，提供一定的参考意义。