应用心率变异性对急性脊髓损伤后自主神经功能评价的研究

发布时间：2018-06-17 08:43

本文选题：心率变异性 + 脊髓损伤　；参考：《广西医科大学》2016年硕士论文

【摘要】：目的脊髓损伤(spinal cord injury, SCI)常导致严重的自主神经(autonomic nervous system, ANS)功能障碍,C1-T5 SCI影响脊髓上对心脏控制及影响脊髓交感神经支配心脏,而T6-T12 SCI交感神经对心脏无明显影响。心率变异性(Heart rate variability, HRV)已经被证实可用于检测ANS的方法。本研究利用HRV评价急性SCI后ANS的变化情况,包括损伤后应激状态的HRV的变化。旨在为临床研究和临床评价ANS功能提供依据。方法选取入住广西医科大学脊柱外科及康复科SCI的患者,符合标准的72例纳入本研究。根据脊髓神经损伤平面,将其分为C1-T5组和T6-T12组。C1-T5组37例,其中入院时12例、术后13例、康复治疗后12例；T6-T12组35例,其中入院时11例,术后13例,康复治疗后11例。根据美国脊髓损伤学会(American Spinal Injury Association ASIA)残损分级,将其分为完全损伤组和不完全损伤组。完全损伤组31例,其中入院时10例,术后12例,康复治疗后9例；不完全损伤组41例,其中入院时13例,术后14例,康复治疗后14例。收集入院时时(受伤3-7天)、术后(术后3天)、康复治疗后(康复治疗3周)24小时动态心电图,分析指标高频功率(high-Frequency Power HF)、低频功率(Low-Frequency Power LF)、LF/HF、超过50ms的个数占总(The proportions of successive NN interval changes greater than 50ms divided by the PNN50)、差值均方的平方根(the square root of the mean squared differences of successive NN intervals rMSSD)、均值标准差(The standard deviation of the average NN intervals SDANN)。结果入院时C1-T5组与T6-T12组相比：LF/HF非常显著降低,高频指标显著增高,完全损伤组与不完全损伤相比：HRV无论高频部分还是低频部分都不同程度降低；康复治疗后C1-T5组与T6-T12组相比：LF/HF显著降低,完全损伤组与不完全损伤相比：HRV无论高频部分还是低频部分不同程度降低；术后与入院时对比：C1-T5高频部分显著降低,T6-T12组除SDANN差别无统计学意义,LF/HF升高,其余指标不同程度的降低,完全损伤组术后与入院时对比无论高频部分,还是低频部分均差别无统计学意义,不完全损伤组术后与入院时对比除LF/HF值升高外,其余均降低；康复治疗后与入院时对比：C1-T5组SDANN显著升高；T6-T12差别无统计学意义；完全损伤差别无统计学意义；不完全损伤组SDANN显著升高,其余指标差别无统计学意义。结论急性期SCI损伤的平面越高,迷走神经张力越占优势,损伤程度越严重,自主神经系统损伤越严重；完全性SCI急性期应激机制可能受到抑制；C1-T5 SCI的患者伤后1个月尚未达到交感迷走平衡,C1-T5 SCI较T6-T12 SCI副交感神经更占优势；完全性SCI的患者在伤后约1月时自主神经功能恢复较差,不完全性SCI患者自主神经恢复较完全性SCI患者好。
[Abstract]:Objective cord injury often leads to severe autonomic nervous system dysfunction. C1-T5 sci affects the cardiac control and sympathetic innervation of the spinal cord, but T6-T12 sci has no significant effect on the heart. Heart rate variability (HRV) has been proven to be a method for detecting ans. In this study, HRV was used to evaluate the changes of ans after acute sci, including the changes of stress state after injury. The aim is to provide evidence for clinical study and evaluation of ans function. Methods 72 patients admitted to spinal surgery and rehabilitation department of Guangxi Medical University were included in this study. According to the level of spinal cord nerve injury, 37 cases were divided into C1-T5 group and T6-T12 group. Among them, 12 cases were admitted to hospital, 13 cases were postoperative, and 35 cases were treated with T6-T12 after rehabilitation. Among them, 11 cases were in admission, 13 cases after operation, 11 cases after rehabilitation. American Spinal injury Association (ASIA) was divided into complete injury group and incomplete injury group according to the damage grade of American Spinal injury Association (ASIA). There were 31 cases of complete injury group, including 10 cases at admission, 12 cases after operation, 9 cases after rehabilitation, and 41 cases in incomplete injury group, including 13 cases on admission, 14 cases after operation and 14 cases after rehabilitation. Ambulatory electrocardiogram (ECG) was collected at admission time (3-7 days after injury), postoperative (3 days after operation) and 24 hours after rehabilitation (3 weeks after rehabilitation treatment). The index of analysis is high-frequency power, low-frequency power and low-frequency power, the number of 50ms exceeds the proportions of successive NN interval changes greater than 50ms divided by the PNN50, the square root of the difference value mean square is the square root of the mean squared differences of successive NN intervals 50ms, and the standard deviation of the mean value is the standard deviation of the average NN intervals SDANN. The number of 50ms exceeds the proportions of successive NN interval changes greater than 50ms divided by the PNN50, the square root of the difference value mean square is the standard deviation of the average NN intervals SDANN, and the standard deviation of the mean value is the standard deviation of the average NN intervals SDANN. Results compared with T6-T12 group, the ratio of F / F and HF in C1-T5 group was significantly lower than that in T6-T12 group, and the high frequency index was significantly higher in C1-T5 group than in T6-T12 group. The ratio of high frequency part and low frequency part in complete injury group was lower than that in incomplete injury group. After rehabilitation treatment, compared with T6-T12 group, WLF / HF decreased significantly in C1-T5 group, and HRV was decreased in full injury group and incomplete injury group in both high frequency and low frequency parts. There was no significant difference in SDANN between the two groups except SDANN, and the other indexes were decreased to some extent. The postoperative and admission high frequency parts were compared between the complete injury group and the admission group, and the high frequency part was significantly lower in the T6-T12 group than in the complete injury group. There was no significant difference between the low frequency and the low frequency, except for the increase of LF / HF, there was no significant difference in SDANN and T6-T12 between the rehabilitation group and the admission group after rehabilitation, and there was no significant difference between the two groups after the rehabilitation treatment and at the time of admission, and there was no significant difference between the two groups in terms of SDANN and T6-T12. In incomplete injury group, SDANN was significantly increased, but no significant difference was found in other indexes. Conclusion the higher the level of sci injury in the acute stage, the more dominant the vagal tension, the more serious the injury, the more serious the autonomic nervous system injury, the more severe the stress mechanism of complete sci may be. One month after injury, C1-T5 sci did not reach the balance of sympathetic vagus. C1-T5 sci was superior to T6-T12 sci in parasympathetic nerves, and complete sci patients had poor autonomic nerve function at about 1 month after injury. The recovery of autonomic nervous system in incomplete sci patients was better than that in complete sci patients.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R651.2

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