心率昼夜节律与四种老年常见疾病自主神经功能紊乱的相关性研究

发布时间：2018-01-19 21:27

  本文关键词： 心率昼夜节律 心率变异性 老年常见疾病 自主神经功能紊乱　出处：《吉林大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的： 随着人民生活水平的不断提高，人们的寿命逐渐延长，包括中国在内的许多国家已进入老龄化社会，给医疗卫生事业带来了巨大的压力和负担，如何优化老年常见疾病的治疗并合理分配使用医疗资源，提高老年人群的生活质量是我们面临的共同难题。CHD、EH、DM、BPH已成为四大老年常见疾病，严重影响着老年人甚至整个家庭的生活质量。大量研究提示CHD、EH、DM、BPH的发生发展过程中存在与心血管不良事件的发生风险和死亡风险密切相关的环节-自主神经功能紊乱。心率昼夜节律为测定自主神经功能的新指标，目前在临床上的主要应用价值为预测CHD、EH、心力衰竭等某一老年常见疾病的预后，但很多老年患者同时合并多种疾病，如将这种预测价值可延伸应用到患多种常见疾病的人群中意义重大。关于心率昼夜节律变化规律与同时合并多种老年常见疾病的自主神经功能紊乱间的相关性研究尚未见报道，本研究应用24小时动态心电图测定心率昼夜节律和HRV，探讨心率昼夜节律变化规律与合并多种老年常见疾病时的自主神经功能紊乱间的相关性，为预测疾病预后和优化老年常见疾病治疗提供依据。 方法： 选取2014年8月-2015年2月在吉林大学第一医院老年干部科住院并完成动态心电图的患者144名，年龄≥60岁（平均75.67±9.10岁），根据所患常见疾病（包括CHD、EH、DM、BPH）数量分为四组，A组（未患常见疾病n=11）、B组（患一种常见疾病n=36）、C组（患两种常见疾病n=59）和D组（患三种以上常见疾病n=38），对年龄、性别构成比、平素用药情况、昼间平均心率、夜间平均心率、24小时平均心率、心率昼夜节律和节律值、SDNN、SDANN、rMSSD、三角指数进行分析比较。分析结果应用统计软件SPSS17.0进行统计学分析，以P 0.05为差异有统计学意义。 结果： 心率昼夜节律异常程度与所患老年常见疾病数量正相关（r=0.611，P＜0.05），所患老年常见疾病越多，心率昼夜节律异常程度越重。四组间性别构成比、夜间平均心率和24小时平均心率无统计学差异（P＞0.05）。四组年龄和用药人数所占比例随所患老年常见疾病的增多而逐渐增大，差异有统计学意义（P＜0.05）；昼间平均心率、心率昼夜节律值、SDNN、rMSSD、SDANN、三角指数随所患老年常见疾病的增多而逐渐下降，差异具有统计学意义（P＜0.05）。 结论： 1、冠状动脉硬化性心脏病、原发性高血压、糖尿病、良性前列腺增生症中，，所患疾病越多，心率昼夜节律值越低，心率昼夜节律异常程度越重，自主神经功能紊乱越重。 2、冠状动脉硬化性心脏病、原发性高血压、糖尿病、良性前列腺增生症中，所患疾病越多，心率变异性下降越明显，自主神经功能紊乱越重。 3、心率昼夜节律和心率变异性变化趋势相一致。 4、同时检测心率昼夜节律和心率变异性可提高老年常见疾病自主神经功能紊乱的检出率。
[Abstract]:Objective: With the continuous improvement of people's living standards, people's life expectancy is gradually prolonged. Many countries, including China, have entered an aging society, which has brought great pressure and burden to medical and health care. How to optimize the treatment of common diseases and allocate medical resources rationally and improve the quality of life of the elderly is a common problem we face. BPH has become a common disease in the elderly, which seriously affects the quality of life of the elderly and even the whole family. In the course of occurrence and development of BPH, there is a link closely related to the risk of cardiovascular adverse events and death-autonomic nervous dysfunction. Heart rate circadian rhythm is a new indicator for the determination of autonomic nervous function. At present, the main clinical value is to predict the prognosis of CHDD-EH, heart failure and other common diseases in the elderly, but many elderly patients with multiple diseases at the same time. If this predictive value can be extended to the population suffering from many common diseases, it is of great significance. A study on the correlation between the circadian rhythm of heart rate and the autonomic nervous dysfunction associated with multiple common diseases in the elderly at the same time. The investigation has not yet been reported. In this study, the 24-hour ambulatory electrocardiogram was used to measure the circadian rhythm of heart rate and HRV, and to explore the relationship between the circadian rhythm of heart rate and the autonomic nervous dysfunction in patients with common diseases in the elderly. To predict the prognosis of diseases and optimize the treatment of common diseases in the elderly. Methods: A total of 144 patients were selected from August 2014 to February 2015 who were hospitalized in the Department of elderly cadres of the first Hospital of Jilin University and completed the ambulatory electrocardiogram. The age 鈮

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