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目的观察急性脑梗死患者心率变异性特点,分析其与发病90 d后预后的相关性。方法选取急性脑梗死患者47例(半球梗死30例,脑干梗死17例;大动脉粥样硬化型21例,小动脉闭塞型16例及其他10例),健康体检者30例。记录所有对象年龄、血化验、24 h动态心电图心率变异性指标,并随访患者发病90 d后m RS得分情况。结果半球梗死组、脑干梗死组较健康对照组NN间期标准差(SDNN)、相邻NN间期差值均方的平方根(r MSSD)、相邻NN间期之差>50 ms的个数占总心搏次数的百分比(p NN50)、低频功率(LF)、高频功率(HF)降低,LF/HF升高;半球梗死组较脑干梗死组SDNN、LF/HF升高,HF降低;大动脉粥样硬化组较小动脉闭塞组SDNN、r MSSD降低,LF、LF/HF升高,差异均有统计学意义(P<0.05);相关性分析示SDNN、r MSSD与发病90 d不良预后呈负相关(r值分别为-0.351、-0.368,均P<0.05),LF、LF/HF与不良预后正相关(r值分别为0.333、0.380,均P<0.05)。结论不同部位、病因的脑梗死患者心率变异性变化亦不同,心率变异性对脑梗死预后具有提示意义。
Objective To observe the characteristics of heart rate variability in patients with acute cerebral infarction and analyze its correlation with the prognosis after 90 days. Methods Forty-seven patients with acute cerebral infarction (hemisphere infarction in 30 cases, infarction in brainstem in 17 cases, atherosclerosis in 21 cases, arteriole occlusion in 16 cases and others in 10 cases) and 30 healthy subjects were included in this study. All subjects were recorded for age, blood test, 24 h Holter ECG heart rate variability index, and follow-up of patients after 90 d m RS score. Results Compared with healthy control group, the mean value of standard deviation (SDNN), square root of mean square error (r MSSD) of adjacent NN interval, the difference of adjacent NN interval> 50 ms (P NN50), low frequency power (LF), high frequency power (HF) and LF / HF were increased in the hemispheric infarction group compared with those in the brainstem infarction group (P <0.05); The correlation analysis showed that SDNN, r MSSD and the onset of 90 d (R = -0.351, -0.368, respectively, P <0.05). LF, LF / HF were positively correlated with adverse prognosis (r = 0.333,0.380, all P <0.05). Conclusion The changes of heart rate variability in patients with different parts and etiology of cerebral infarction are also different. The heart rate variability has a significant meaning on the prognosis of cerebral infarction.