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目的探讨阵发性房颤患者心率减速力(deceleration capacity of rate,DC)的变化及其临床意义。方法选取2015年1月至2016年10月我院住院患者中确诊为阵发性房颤的90例患者(PAF组)和同时期健康体检者133例(对照组),行24 h动态心电图和心脏超声心动图检查,分析并比较两组的心率减速力(DC)、心率加速力(AC)、心率变异性(HRV)指标以及左房内径(LAD)和左室射血分数(LVEF)。结果 (1)与对照组相比,PAF组患者的DC值、AC绝对值、SDNN、r MSSD和LAD值均显著升高(P<0.05),24 h平均心率和LF/HF指标均显著降低(P<0.05)。(2)无论是对照组还是PAF组,其组内男女间DC值无明显差异,但与对照组同性别间相比,PAF组男性DC值显著升高(P<0.05),而女性DC值呈升高趋势。(3)无论是对照组还是PAF组,其DC值与年龄均呈负相关(r<-0.262 vs.r<-0.548,P均<0.01);与对照组同年龄段者相比,PAF组年龄<60岁者的DC值显著升高(P<0.05),而≥60岁者的DC值呈升高趋势。(4)与对照组相比,PAF组LAD值显著升高(P<0.05),但PAF组患者无论是LAD≤40 mm还是LAD>40 mm,其DC值均显著高于对照组(P<0.05)。结论阵发性房颤患者的DC值升高,提示迷走神经张力增加。该指标与患者年龄呈负相关。
Objective To investigate the changes of decelerating capacity of rate (DC) in patients with paroxysmal atrial fibrillation and its clinical significance. Methods 90 patients (PAF group) diagnosed as paroxysmal atrial fibrillation in our hospital from January 2015 to October 2016 and 133 healthy controls (control group) were enrolled in this study. The dynamic electrocardiogram Cardiac echocardiography was performed to analyze and compare heart rate deceleration (DC), heart rate acceleration (AC), heart rate variability (HRV) and left atrium (LAD) and left ventricular ejection fraction (LVEF). Results (1) Compared with the control group, the values of DC, AC absolute value, SDNN, r MSSD and LAD in PAF group were significantly increased (P <0.05), and the average heart rate and LF / HF index in 24 h were significantly lower (P <0.05). (2) There was no significant difference in DC between men and women in both control and PAF groups, but the values of male DC in PAF group were significantly higher than those in control group (P <0.05) Showing an upward trend. (3) There was a negative correlation between DC value and age in both control group and PAF group (r <-0.262 vs. r <-0.548, all P <0.01). Compared with the same age group in the control group, PAF group The DCs in patients <60 years of age were significantly increased (P <0.05), while the DCs in ≥60 years of age showed an increasing trend. (4) The LAD of PAF group was significantly higher than that of the control group (P <0.05), but the DC value of PAF group was significantly higher than that of the control group (LAD≤40 mm or LAD> 40 mm, P < 0.05). Conclusion The DC value of patients with paroxysmal atrial fibrillation increased, suggesting that vagal tone increased. The index was negatively correlated with patient’s age.