本文關(guān)鍵詞： 心率晝夜節(jié)律 心率變異性 老年常見疾病 自主神經(jīng)功能紊亂　出處：《吉林大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 隨著人民生活水平的不斷提高，人們的壽命逐漸延長，包括中國在內(nèi)的許多國家已進(jìn)入老齡化社會，給醫(yī)療衛(wèi)生事業(yè)帶來了巨大的壓力和負(fù)擔(dān)，如何優(yōu)化老年常見疾病的治療并合理分配使用醫(yī)療資源，提高老年人群的生活質(zhì)量是我們面臨的共同難題。CHD、EH、DM、BPH已成為四大老年常見疾病，嚴(yán)重影響著老年人甚至整個(gè)家庭的生活質(zhì)量。大量研究提示CHD、EH、DM、BPH的發(fā)生發(fā)展過程中存在與心血管不良事件的發(fā)生風(fēng)險(xiǎn)和死亡風(fēng)險(xiǎn)密切相關(guān)的環(huán)節(jié)-自主神經(jīng)功能紊亂。心率晝夜節(jié)律為測定自主神經(jīng)功能的新指標(biāo)，目前在臨床上的主要應(yīng)用價(jià)值為預(yù)測CHD、EH、心力衰竭等某一老年常見疾病的預(yù)后，但很多老年患者同時(shí)合并多種疾病，如將這種預(yù)測價(jià)值可延伸應(yīng)用到患多種常見疾病的人群中意義重大。關(guān)于心率晝夜節(jié)律變化規(guī)律與同時(shí)合并多種老年常見疾病的自主神經(jīng)功能紊亂間的相關(guān)性研究尚未見報(bào)道，本研究應(yīng)用24小時(shí)動(dòng)態(tài)心電圖測定心率晝夜節(jié)律和HRV，探討心率晝夜節(jié)律變化規(guī)律與合并多種老年常見疾病時(shí)的自主神經(jīng)功能紊亂間的相關(guān)性，為預(yù)測疾病預(yù)后和優(yōu)化老年常見疾病治療提供依據(jù)。 方法： 選取2014年8月-2015年2月在吉林大學(xué)第一醫(yī)院老年干部科住院并完成動(dòng)態(tài)心電圖的患者144名，年齡≥60歲（平均75.67±9.10歲），根據(jù)所患常見疾�。ò–HD、EH、DM、BPH）數(shù)量分為四組，A組（未患常見疾病n=11）、B組（患一種常見疾病n=36）、C組（患兩種常見疾病n=59）和D組（患三種以上常見疾病n=38），對年齡、性別構(gòu)成比、平素用藥情況、晝間平均心率、夜間平均心率、24小時(shí)平均心率、心率晝夜節(jié)律和節(jié)律值、SDNN、SDANN、rMSSD、三角指數(shù)進(jìn)行分析比較。分析結(jié)果應(yīng)用統(tǒng)計(jì)軟件SPSS17.0進(jìn)行統(tǒng)計(jì)學(xué)分析，以P 0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 心率晝夜節(jié)律異常程度與所患老年常見疾病數(shù)量正相關(guān)（r=0.611，P＜0.05），所患老年常見疾病越多，心率晝夜節(jié)律異常程度越重。四組間性別構(gòu)成比、夜間平均心率和24小時(shí)平均心率無統(tǒng)計(jì)學(xué)差異（P＞0.05）。四組年齡和用藥人數(shù)所占比例隨所患老年常見疾病的增多而逐漸增大，差異有統(tǒng)計(jì)學(xué)意義（P＜0.05）；晝間平均心率、心率晝夜節(jié)律值、SDNN、rMSSD、SDANN、三角指數(shù)隨所患老年常見疾病的增多而逐漸下降，差異具有統(tǒng)計(jì)學(xué)意義（P＜0.05）。 結(jié)論： 1、冠狀動(dòng)脈硬化性心臟病、原發(fā)性高血壓、糖尿病、良性前列腺增生癥中，，所患疾病越多，心率晝夜節(jié)律值越低，心率晝夜節(jié)律異常程度越重，自主神經(jīng)功能紊亂越重。 2、冠狀動(dòng)脈硬化性心臟病、原發(fā)性高血壓、糖尿病、良性前列腺增生癥中，所患疾病越多，心率變異性下降越明顯，自主神經(jīng)功能紊亂越重。 3、心率晝夜節(jié)律和心率變異性變化趨勢相一致。 4、同時(shí)檢測心率晝夜節(jié)律和心率變異性可提高老年常見疾病自主神經(jīng)功能紊亂的檢出率。
[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

本文編號：1445592