本文選題：心率變異性 + 脊髓損傷　； 參考：《廣西醫(yī)科大學》2016年碩士論文

【摘要】：目的脊髓損傷(spinal cord injury, SCI)常導致嚴重的自主神經(jīng)(autonomic nervous system, ANS)功能障礙,C1-T5 SCI影響脊髓上對心臟控制及影響脊髓交感神經(jīng)支配心臟,而T6-T12 SCI交感神經(jīng)對心臟無明顯影響。心率變異性(Heart rate variability, HRV)已經(jīng)被證實可用于檢測ANS的方法。本研究利用HRV評價急性SCI后ANS的變化情況,包括損傷后應激狀態(tài)的HRV的變化。旨在為臨床研究和臨床評價ANS功能提供依據(jù)。方法選取入住廣西醫(yī)科大學脊柱外科及康復科SCI的患者,符合標準的72例納入本研究。根據(jù)脊髓神經(jīng)損傷平面,將其分為C1-T5組和T6-T12組。C1-T5組37例,其中入院時12例、術后13例、康復治療后12例；T6-T12組35例,其中入院時11例,術后13例,康復治療后11例。根據(jù)美國脊髓損傷學會(American Spinal Injury Association ASIA)殘損分級,將其分為完全損傷組和不完全損傷組。完全損傷組31例,其中入院時10例,術后12例,康復治療后9例；不完全損傷組41例,其中入院時13例,術后14例,康復治療后14例。收集入院時時(受傷3-7天)、術后(術后3天)、康復治療后(康復治療3周)24小時動態(tài)心電圖,分析指標高頻功率(high-Frequency Power HF)、低頻功率(Low-Frequency Power LF)、LF/HF、超過50ms的個數(shù)占總(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)、均值標準差(The standard deviation of the average NN intervals SDANN)。結果入院時C1-T5組與T6-T12組相比：LF/HF非常顯著降低,高頻指標顯著增高,完全損傷組與不完全損傷相比：HRV無論高頻部分還是低頻部分都不同程度降低；康復治療后C1-T5組與T6-T12組相比：LF/HF顯著降低,完全損傷組與不完全損傷相比：HRV無論高頻部分還是低頻部分不同程度降低；術后與入院時對比：C1-T5高頻部分顯著降低,T6-T12組除SDANN差別無統(tǒng)計學意義,LF/HF升高,其余指標不同程度的降低,完全損傷組術后與入院時對比無論高頻部分,還是低頻部分均差別無統(tǒng)計學意義,不完全損傷組術后與入院時對比除LF/HF值升高外,其余均降低；康復治療后與入院時對比：C1-T5組SDANN顯著升高；T6-T12差別無統(tǒng)計學意義；完全損傷差別無統(tǒng)計學意義；不完全損傷組SDANN顯著升高,其余指標差別無統(tǒng)計學意義。結論急性期SCI損傷的平面越高,迷走神經(jīng)張力越占優(yōu)勢,損傷程度越嚴重,自主神經(jīng)系統(tǒng)損傷越嚴重；完全性SCI急性期應激機制可能受到抑制；C1-T5 SCI的患者傷后1個月尚未達到交感迷走平衡,C1-T5 SCI較T6-T12 SCI副交感神經(jīng)更占優(yōu)勢；完全性SCI的患者在傷后約1月時自主神經(jīng)功能恢復較差,不完全性SCI患者自主神經(jīng)恢復較完全性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.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R651.2

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