非器质性室性期前收缩与心率变异性和心功能的相关性分析
发布时间：2018-08-17 13:16
【摘要】：室性期前收缩(Premature Ventricular Contraction,PVC)是早搏中常见的一种心律失常。正常人和患有各种器质性心脏疾病的人都可以发生室性期前收缩。正常情况下,心脏节律会随着身体机能状况和日夜节律而发生变化,这种心率的规则性变化,称为心率变异性(Heart Rate Variability,HRV)。目的:探讨非器质性室性期前收缩的昼夜节律变化及不同负荷的非器质性室性期前收缩患者分别对心率变异性和左心功能的影响,从而为临床上非器质性室性期前收缩患者的治疗提供参考。方法:1研究对象收集2015年9月至2017年1月在辽宁省朝阳市中心医院门诊部和住院部行动态心电图和询问病史发现非器质性室性期前收缩患者135名,男性72名,女性63名。其中有103名患者行心脏多普勒超声检查,男性52名,女性51名。2选取135名非器质性室性期前收缩患者2.1根据非器质性室性期前收缩不同负荷分为三组,即低负荷组85名(10%),中负荷组34名(10%~20%),高负荷组16名(20%)。对比不同负荷组间SDNN、SDNN Idx、SDANN、r MMSD等心率变异性时域指标的不同,并分析其相关性。2.2根据动态心电图时间,将非器质性室性期前收缩分为日间组78名(06:00~18:00)和夜间组57名(18:00~次日06:00)。日间组:日间非器质性室性期前收缩次数占全日非器质性室性期前收缩总数的50%以上。夜间组:夜间非器质性室性期前收缩次数占全日非器质性室性期前收缩总数的50%以上。对比日间和夜间两组间SDNN、SDNN Idx、SDANN、r MMSD等心率变异性时域指标的不同,并分析其相关性。2.3根据动态心电图中的24小时数据图,记录每个时间段(01:00~24:00)室性期前收缩发生的次数。分析不同负荷间非器质性室性期前收缩的昼夜节律变化和日间组与夜间组非器质性室性期前收缩昼夜节律的变化。3选取135名患者中行心脏多普勒超声检查的103名患者3.1根据非器质性室性期前收缩不同负荷分为三组,即低负荷组66名(10%),中负荷组25名(10%~20%),高负荷组12名(20%),分析不同负荷的非器质性室性期前收缩对左房内径(Left Atrial Diameter,LAD)、室间隔厚度(Interventricular Septum Thickness,IVST)、左室舒张末内径(Left Ventricular End Diastolic Diameter,LVEDD),左室后壁厚度(Left Ventricular Posterior Wall thickness,LVPW)、左室射血分数(Left Ventricular Ejection Fraction,LVEF)等各项心功能指标的影响。3.2根据动态心电图时间,分为日间组58名(06:00~18:00)和夜间组45名(18:00~次日06:00)。对比日间为主的非器质性室性期前收缩和夜间为主的非器质性室性期前收缩分别对左房内径(LAD)、室间隔厚度(IVST)、左室舒张末内径(LVEDD)、左室后壁厚度(LVPW)、左室射血分数(LVEF)等各项心功能指标的影响。4统计学分析使用SPSS 19.0统计软件进行统计学处理,计量资料以均数±标准差(sx±)表示,多组间均数比较采用方差分析,两组间均数比较采用独立样本的t检验。计数资料以χ2表示。P0.05为差异有统计学意义。结果:1 135名非器质性室性期前收缩患者临床资料的比较1.1不同负荷室性期前收缩患者心率变异性基础资料的比较,年龄和性别3组差异无统计学意义(P0.05),而室性期前收缩总数3组比较差异有统计学意义(P0.01)。随着非器质性室性期前收缩负荷的增高,室性期前收缩发生的次数也增加。1.2日间组和夜间组室性期前收缩患者心率变异性基础资料的比较,年龄、性别、室性期前收缩总数2组差异无统计学意义(P0.05)。2 103名非器质性室性期前收缩患者临床资料的比较2.1不同负荷室性期前收缩患者心功能基础资料的比较,年龄和性别3组差异无统计学意义(P0.05),而室性期前收缩总数3组比较差异有统计学意义(P0.01)。随着非器质性室性期前收缩负荷的增高,室性期前收缩发生的次数也增加。2.2日间组和夜间组室性期前收缩患者心功能基础资料的比较,年龄、性别、室性期前收缩总数2组差异无统计学意义(P0.05)。3 135名非器质性室性期前收缩患者心率变异性指标的比较3.1不同非器质性室性期前收缩负荷之间心率变异性指标的比较,3组间SDNN Idx、r MMSD指标差异无统计学意义(P0.05)。SDNN指标,低负荷和中负荷比较差异有统计学意义(P0.05)。低负荷和高负荷比较差异有统计学意义(P0.05)。随着非器质性室性期前收缩负荷的增高,SDNN数值逐渐下降。SDANN指标,低负荷和中负荷比较差异有统计学意义(P0.05),低负荷和高负荷比较差异有统计学意义(P0.05)。随着非器质性室性期前收缩负荷的增高,SDANN数值逐渐下降。3.2日间型非器质性室性期前收缩和夜间型非器质性室性期前收缩患者心率变异性时域指标比较,SDNN、SDNN Idx、SDANN等指标差异无统计学意义(P0.05)。r MMSD指标差异有统计学意义(P0.05)。与日间组相比,夜间组r MMSD数值明显下降。4 135名非器质性室性期前收缩患者室性期前收缩次数昼夜的分布规律高负荷的非器质性室性期前收缩发生的次数在上午10:00左右达高峰,在凌晨1:00左右达到低谷。日间型为主的非器质性室性期前收缩发生的次数也在上午10:00左右达高峰,在凌晨1:00左右达到低谷,而夜间型为主的非器质性室性期前收缩发生的次数在凌晨1:00左右达到高峰,在下午13:00左右达到低谷。5 103名非器质性室性期前收缩患者心功能指标的比较5.1不同非器质性室性期前收缩负荷之间心功能指标的比较,3组间左房内径(LAD)、室间隔厚度(IVST)、左室舒张末内径(LVEDD)、左室后壁厚度(LVPW)等指标差异无统计学意义(P0.05)。低负荷组的左室射血分数(LVEF)指标与高负荷比较差异有统计学意义(P0.05)。随着非器质性室性期前收缩负荷的增加,左室射血分数的数值逐渐降低。5.2日间型非器质性室性期前收缩和夜间型非器质性室性期前收缩患者心功能指标的比较,左房内径(LAD)、室间隔厚度(IVST)、左室舒张末内径(LVEDD)、左室后壁厚度(LVPW)、左室射血分数(LVEF)等各项指标差异无统计学意义(P0.05)。结论:1随着非器质性室性期前收缩负荷的增加,SDNN、SDANN指标数值显著降低,主要与自主神经功能受损有关。高负荷的非器质性室性期前收缩患者交感神经增强更明显。2日间型为主的非器质性室性期前收缩和夜间型为主的非器质性室性期前收缩患者比较,夜间r MMSD指标数值显著降低,主要与副交感神经受损有关;3非器质性室性期前收缩呈昼夜节律变化。随着非器质性室性期前收缩负荷的增高,室性期前收缩发生的次数也增加。4随着非器质性室性期前收缩负荷的增加,左室射血分数逐渐下降。高负荷的非器质性室性期前收缩更易引起左室射血分数的降低。5日间型为主的非器质性室性期前收缩和夜间型为主的非器质性室性期前收缩对左心室功能的影响不大。
[Abstract]:Premature Ventricular Contraction (PVC) is a common arrhythmia in premature beats. Preventricular contraction can occur in normal people and people with various organic heart diseases. Objective: To investigate the circadian rhythm of non-organic premature ventricular contraction (NVPS) and the effects of different loads of NVPS on heart rate variability (HRV) and left ventricular function in patients with NVPS. A total of 135 patients (72 males and 63 females) with non-organic premature ventricular contraction (NVPS) were investigated by ambulatory electrocardiogram (AECG) and medical history from September 2015 to January 2017 in the outpatient and inpatient departments of Chaoyang Central Hospital, Liaoning Province. Patients with organic premature ventricular systole 2.1 were divided into three groups according to different loads of non-organic premature ventricular systole: low-load group 85 (10%), medium-load group 34 (10%-20%) and high-load group 16 (20%). The non-organic premature ventricular systole was divided into daytime group (78 cases) and night group (57 cases). daytime group: the number of non-organic premature ventricular systole in daytime accounted for more than 50% of the total number of non-organic premature ventricular systole in the whole day. nocturnal group: the number of non-organic premature ventricular systole in the whole day accounted for more than 50%. The time domain indexes of heart rate variability (HRV) were compared between daytime and nighttime groups, and their correlation was analyzed. 2.3 According to the 24-hour data of dynamic electrocardiogram, the occurrence times of pre-ventricular systole in each time period (01:00-24:00) were recorded. The circadian rhythm of non-organic premature ventricular systole and the circadian rhythm of non-organic premature ventricular systole in daytime group and nighttime group. 3.1 103 patients with cardiac Doppler echocardiography were divided into three groups according to different loads of non-organic premature ventricular systole: 66 patients with low load (10%) and 25 patients with medium load (25%). Left Atrial Diameter (LAD), Interventricular Septum Thickness (IVST), Left Ventricular End Diastolic Diameter (LVEDD), Left Ventricular Posterior Wall Thickness (LVPT) were analyzed in 12 patients (20%) with high load and 10% ~ 20% with high load. Wall thickness, LVPW, left ventricular ejection fraction (LVEF) and other cardiac function indicators. 3.2 According to the time of ambulatory electrocardiogram, 58 patients were divided into day group (06:00-18:00) and 45 patients were divided into night group (18:00-06:00). The effects of pre-ventricular systole on left atrial diameter (LAD), interventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVEDD), left ventricular posterior wall thickness (LVPW), left ventricular ejection fraction (LVEF) and other cardiac function indices were analyzed by SPSS 19.0 statistical software. The measurements were expressed by mean (+) standard deviation (sx (+). Results: 1 135 patients with non-organic premature ventricular systole were compared in clinical data. 1. Comparison of basic data of heart rate variability, age and sex in patients with different loads of premature ventricular systole There was no significant difference among the three groups (P 0.05), but there was significant difference in the total number of ventricular premature contractions among the three groups (P 0.01). There was no significant difference in the total number of premature ventricular contractions between the two groups (P 0.05). The clinical data of 2 103 patients with non-organic premature ventricular contractions were compared. 2.1 There was no significant difference in cardiac function between the three groups of age and sex (P 0.05), but there was no significant difference in the total number of premature ventricular contractions among the three groups of different load. There was no significant difference in age, sex and total number of non-organic premature ventricular systoles between the two groups (P 0.05). 3 135 patients with non-organic premature ventricular systoles had no significant difference (P 0.05). Comparison of heart rate variability in pre-systolic patients 3.1 Comparison of heart rate variability between different non-organic pre-ventricular systolic loads showed that there was no significant difference between the three groups (P 0.05). SDANN values gradually decreased with the increase of non-organic premature ventricular systolic load (P 0.05). There were significant differences in SDANN indexes between low and medium load (P 0.05), and between low and high load (P 0.05). SDANN values gradually decreased with the increase of non-organic premature ventricular systolic load. There was no significant difference in heart rate variability between 2-day non-organic premature ventricular systole and nocturnal non-organic premature ventricular systole (P 0.05). There was significant difference in r-MMSD between 2-day non-organic premature systole and nocturnal non-organic premature ventricular systole (P 0.05). The frequency of non-organic premature ventricular contraction with high load reached its peak at about 10:00 a.m. and its peak at about 1:00 a.m. The frequency of non-organic premature ventricular contraction with daytime predominance also reached its peak at about 10:00 a.m. and at 1:0 a.m. The number of nocturnal non-organic premature ventricular contractions peaked at about 1:00 a.m. and reached a low at about 13:00 p.m. There was no significant difference in LAD, IVST, LVEDD and LVPW between low load group and high load group (P 0.05). There was significant difference in LVEF between low load group and high load group (P 0.05). There was no significant difference in left atrial diameter (LAD), interventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVEDD), left ventricular posterior wall thickness (LVPW), left ventricular ejection fraction (LVEF) between the two groups (P CONCLUSION: 1. With the increase of non-organic premature ventricular systolic load, the values of 65 Compared with patients with premature ventricular systole, the nocturnal r-MMSD index was significantly lower, mainly related to parasympathetic nerve damage; 3 Non-organic premature ventricular systole showed circadian rhythm changes. With the increase of non-organic premature ventricular systolic load, the frequency of premature ventricular systole also increased. 4 With non-organic premature ventricular systolic load. The left ventricular ejection fraction (LVEF) decreased gradually with the increase of LVE ejection fraction (LVEF). Non-organic pre-ventricular systole (NVP) and nocturnal non-organic pre-ventricular systole (NVP) had little effect on LV function.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.7
本文编号：2187752
[Abstract]:Premature Ventricular Contraction (PVC) is a common arrhythmia in premature beats. Preventricular contraction can occur in normal people and people with various organic heart diseases. Objective: To investigate the circadian rhythm of non-organic premature ventricular contraction (NVPS) and the effects of different loads of NVPS on heart rate variability (HRV) and left ventricular function in patients with NVPS. A total of 135 patients (72 males and 63 females) with non-organic premature ventricular contraction (NVPS) were investigated by ambulatory electrocardiogram (AECG) and medical history from September 2015 to January 2017 in the outpatient and inpatient departments of Chaoyang Central Hospital, Liaoning Province. Patients with organic premature ventricular systole 2.1 were divided into three groups according to different loads of non-organic premature ventricular systole: low-load group 85 (10%), medium-load group 34 (10%-20%) and high-load group 16 (20%). The non-organic premature ventricular systole was divided into daytime group (78 cases) and night group (57 cases). daytime group: the number of non-organic premature ventricular systole in daytime accounted for more than 50% of the total number of non-organic premature ventricular systole in the whole day. nocturnal group: the number of non-organic premature ventricular systole in the whole day accounted for more than 50%. The time domain indexes of heart rate variability (HRV) were compared between daytime and nighttime groups, and their correlation was analyzed. 2.3 According to the 24-hour data of dynamic electrocardiogram, the occurrence times of pre-ventricular systole in each time period (01:00-24:00) were recorded. The circadian rhythm of non-organic premature ventricular systole and the circadian rhythm of non-organic premature ventricular systole in daytime group and nighttime group. 3.1 103 patients with cardiac Doppler echocardiography were divided into three groups according to different loads of non-organic premature ventricular systole: 66 patients with low load (10%) and 25 patients with medium load (25%). Left Atrial Diameter (LAD), Interventricular Septum Thickness (IVST), Left Ventricular End Diastolic Diameter (LVEDD), Left Ventricular Posterior Wall Thickness (LVPT) were analyzed in 12 patients (20%) with high load and 10% ~ 20% with high load. Wall thickness, LVPW, left ventricular ejection fraction (LVEF) and other cardiac function indicators. 3.2 According to the time of ambulatory electrocardiogram, 58 patients were divided into day group (06:00-18:00) and 45 patients were divided into night group (18:00-06:00). The effects of pre-ventricular systole on left atrial diameter (LAD), interventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVEDD), left ventricular posterior wall thickness (LVPW), left ventricular ejection fraction (LVEF) and other cardiac function indices were analyzed by SPSS 19.0 statistical software. The measurements were expressed by mean (+) standard deviation (sx (+). Results: 1 135 patients with non-organic premature ventricular systole were compared in clinical data. 1. Comparison of basic data of heart rate variability, age and sex in patients with different loads of premature ventricular systole There was no significant difference among the three groups (P 0.05), but there was significant difference in the total number of ventricular premature contractions among the three groups (P 0.01). There was no significant difference in the total number of premature ventricular contractions between the two groups (P 0.05). The clinical data of 2 103 patients with non-organic premature ventricular contractions were compared. 2.1 There was no significant difference in cardiac function between the three groups of age and sex (P 0.05), but there was no significant difference in the total number of premature ventricular contractions among the three groups of different load. There was no significant difference in age, sex and total number of non-organic premature ventricular systoles between the two groups (P 0.05). 3 135 patients with non-organic premature ventricular systoles had no significant difference (P 0.05). Comparison of heart rate variability in pre-systolic patients 3.1 Comparison of heart rate variability between different non-organic pre-ventricular systolic loads showed that there was no significant difference between the three groups (P 0.05). SDANN values gradually decreased with the increase of non-organic premature ventricular systolic load (P 0.05). There were significant differences in SDANN indexes between low and medium load (P 0.05), and between low and high load (P 0.05). SDANN values gradually decreased with the increase of non-organic premature ventricular systolic load. There was no significant difference in heart rate variability between 2-day non-organic premature ventricular systole and nocturnal non-organic premature ventricular systole (P 0.05). There was significant difference in r-MMSD between 2-day non-organic premature systole and nocturnal non-organic premature ventricular systole (P 0.05). The frequency of non-organic premature ventricular contraction with high load reached its peak at about 10:00 a.m. and its peak at about 1:00 a.m. The frequency of non-organic premature ventricular contraction with daytime predominance also reached its peak at about 10:00 a.m. and at 1:0 a.m. The number of nocturnal non-organic premature ventricular contractions peaked at about 1:00 a.m. and reached a low at about 13:00 p.m. There was no significant difference in LAD, IVST, LVEDD and LVPW between low load group and high load group (P 0.05). There was significant difference in LVEF between low load group and high load group (P 0.05). There was no significant difference in left atrial diameter (LAD), interventricular septal thickness (IVST), left ventricular end-diastolic diameter (LVEDD), left ventricular posterior wall thickness (LVPW), left ventricular ejection fraction (LVEF) between the two groups (P CONCLUSION: 1. With the increase of non-organic premature ventricular systolic load, the values of 65 Compared with patients with premature ventricular systole, the nocturnal r-MMSD index was significantly lower, mainly related to parasympathetic nerve damage; 3 Non-organic premature ventricular systole showed circadian rhythm changes. With the increase of non-organic premature ventricular systolic load, the frequency of premature ventricular systole also increased. 4 With non-organic premature ventricular systolic load. The left ventricular ejection fraction (LVEF) decreased gradually with the increase of LVE ejection fraction (LVEF). Non-organic pre-ventricular systole (NVP) and nocturnal non-organic pre-ventricular systole (NVP) had little effect on LV function.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.7
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