非器質(zhì)性室性期前收縮與心率變異性和心功能的相關性分析
發(fā)布時間：2018-08-17 13:16
【摘要】：室性期前收縮(Premature Ventricular Contraction,PVC)是早搏中常見的一種心律失常。正常人和患有各種器質(zhì)性心臟疾病的人都可以發(fā)生室性期前收縮。正常情況下,心臟節(jié)律會隨著身體機能狀況和日夜節(jié)律而發(fā)生變化,這種心率的規(guī)則性變化,稱為心率變異性(Heart Rate Variability,HRV)。目的:探討非器質(zhì)性室性期前收縮的晝夜節(jié)律變化及不同負荷的非器質(zhì)性室性期前收縮患者分別對心率變異性和左心功能的影響,從而為臨床上非器質(zhì)性室性期前收縮患者的治療提供參考。方法:1研究對象收集2015年9月至2017年1月在遼寧省朝陽市中心醫(yī)院門診部和住院部行動態(tài)心電圖和詢問病史發(fā)現(xiàn)非器質(zhì)性室性期前收縮患者135名,男性72名,女性63名。其中有103名患者行心臟多普勒超聲檢查,男性52名,女性51名。2選取135名非器質(zhì)性室性期前收縮患者2.1根據(jù)非器質(zhì)性室性期前收縮不同負荷分為三組,即低負荷組85名(10%),中負荷組34名(10%~20%),高負荷組16名(20%)。對比不同負荷組間SDNN、SDNN Idx、SDANN、r MMSD等心率變異性時域指標的不同,并分析其相關性。2.2根據(jù)動態(tài)心電圖時間,將非器質(zhì)性室性期前收縮分為日間組78名(06:00~18:00)和夜間組57名(18:00~次日06:00)。日間組:日間非器質(zhì)性室性期前收縮次數(shù)占全日非器質(zhì)性室性期前收縮總數(shù)的50%以上。夜間組:夜間非器質(zhì)性室性期前收縮次數(shù)占全日非器質(zhì)性室性期前收縮總數(shù)的50%以上。對比日間和夜間兩組間SDNN、SDNN Idx、SDANN、r MMSD等心率變異性時域指標的不同,并分析其相關性。2.3根據(jù)動態(tài)心電圖中的24小時數(shù)據(jù)圖,記錄每個時間段(01:00~24:00)室性期前收縮發(fā)生的次數(shù)。分析不同負荷間非器質(zhì)性室性期前收縮的晝夜節(jié)律變化和日間組與夜間組非器質(zhì)性室性期前收縮晝夜節(jié)律的變化。3選取135名患者中行心臟多普勒超聲檢查的103名患者3.1根據(jù)非器質(zhì)性室性期前收縮不同負荷分為三組,即低負荷組66名(10%),中負荷組25名(10%~20%),高負荷組12名(20%),分析不同負荷的非器質(zhì)性室性期前收縮對左房內(nèi)徑(Left Atrial Diameter,LAD)、室間隔厚度(Interventricular Septum Thickness,IVST)、左室舒張末內(nèi)徑(Left Ventricular End Diastolic Diameter,LVEDD),左室后壁厚度(Left Ventricular Posterior Wall thickness,LVPW)、左室射血分數(shù)(Left Ventricular Ejection Fraction,LVEF)等各項心功能指標的影響。3.2根據(jù)動態(tài)心電圖時間,分為日間組58名(06:00~18:00)和夜間組45名(18:00~次日06:00)。對比日間為主的非器質(zhì)性室性期前收縮和夜間為主的非器質(zhì)性室性期前收縮分別對左房內(nèi)徑(LAD)、室間隔厚度(IVST)、左室舒張末內(nèi)徑(LVEDD)、左室后壁厚度(LVPW)、左室射血分數(shù)(LVEF)等各項心功能指標的影響。4統(tǒng)計學分析使用SPSS 19.0統(tǒng)計軟件進行統(tǒng)計學處理,計量資料以均數(shù)±標準差(sx±)表示,多組間均數(shù)比較采用方差分析,兩組間均數(shù)比較采用獨立樣本的t檢驗。計數(shù)資料以χ2表示。P0.05為差異有統(tǒng)計學意義。結(jié)果:1 135名非器質(zhì)性室性期前收縮患者臨床資料的比較1.1不同負荷室性期前收縮患者心率變異性基礎資料的比較,年齡和性別3組差異無統(tǒng)計學意義(P0.05),而室性期前收縮總數(shù)3組比較差異有統(tǒng)計學意義(P0.01)。隨著非器質(zhì)性室性期前收縮負荷的增高,室性期前收縮發(fā)生的次數(shù)也增加。1.2日間組和夜間組室性期前收縮患者心率變異性基礎資料的比較,年齡、性別、室性期前收縮總數(shù)2組差異無統(tǒng)計學意義(P0.05)。2 103名非器質(zhì)性室性期前收縮患者臨床資料的比較2.1不同負荷室性期前收縮患者心功能基礎資料的比較,年齡和性別3組差異無統(tǒng)計學意義(P0.05),而室性期前收縮總數(shù)3組比較差異有統(tǒng)計學意義(P0.01)。隨著非器質(zhì)性室性期前收縮負荷的增高,室性期前收縮發(fā)生的次數(shù)也增加。2.2日間組和夜間組室性期前收縮患者心功能基礎資料的比較,年齡、性別、室性期前收縮總數(shù)2組差異無統(tǒng)計學意義(P0.05)。3 135名非器質(zhì)性室性期前收縮患者心率變異性指標的比較3.1不同非器質(zhì)性室性期前收縮負荷之間心率變異性指標的比較,3組間SDNN Idx、r MMSD指標差異無統(tǒng)計學意義(P0.05)。SDNN指標,低負荷和中負荷比較差異有統(tǒng)計學意義(P0.05)。低負荷和高負荷比較差異有統(tǒng)計學意義(P0.05)。隨著非器質(zhì)性室性期前收縮負荷的增高,SDNN數(shù)值逐漸下降。SDANN指標,低負荷和中負荷比較差異有統(tǒng)計學意義(P0.05),低負荷和高負荷比較差異有統(tǒng)計學意義(P0.05)。隨著非器質(zhì)性室性期前收縮負荷的增高,SDANN數(shù)值逐漸下降。3.2日間型非器質(zhì)性室性期前收縮和夜間型非器質(zhì)性室性期前收縮患者心率變異性時域指標比較,SDNN、SDNN Idx、SDANN等指標差異無統(tǒng)計學意義(P0.05)。r MMSD指標差異有統(tǒng)計學意義(P0.05)。與日間組相比,夜間組r MMSD數(shù)值明顯下降。4 135名非器質(zhì)性室性期前收縮患者室性期前收縮次數(shù)晝夜的分布規(guī)律高負荷的非器質(zhì)性室性期前收縮發(fā)生的次數(shù)在上午10:00左右達高峰,在凌晨1:00左右達到低谷。日間型為主的非器質(zhì)性室性期前收縮發(fā)生的次數(shù)也在上午10:00左右達高峰,在凌晨1:00左右達到低谷,而夜間型為主的非器質(zhì)性室性期前收縮發(fā)生的次數(shù)在凌晨1:00左右達到高峰,在下午13:00左右達到低谷。5 103名非器質(zhì)性室性期前收縮患者心功能指標的比較5.1不同非器質(zhì)性室性期前收縮負荷之間心功能指標的比較,3組間左房內(nèi)徑(LAD)、室間隔厚度(IVST)、左室舒張末內(nèi)徑(LVEDD)、左室后壁厚度(LVPW)等指標差異無統(tǒng)計學意義(P0.05)。低負荷組的左室射血分數(shù)(LVEF)指標與高負荷比較差異有統(tǒng)計學意義(P0.05)。隨著非器質(zhì)性室性期前收縮負荷的增加,左室射血分數(shù)的數(shù)值逐漸降低。5.2日間型非器質(zhì)性室性期前收縮和夜間型非器質(zhì)性室性期前收縮患者心功能指標的比較,左房內(nèi)徑(LAD)、室間隔厚度(IVST)、左室舒張末內(nèi)徑(LVEDD)、左室后壁厚度(LVPW)、左室射血分數(shù)(LVEF)等各項指標差異無統(tǒng)計學意義(P0.05)。結(jié)論:1隨著非器質(zhì)性室性期前收縮負荷的增加,SDNN、SDANN指標數(shù)值顯著降低,主要與自主神經(jīng)功能受損有關。高負荷的非器質(zhì)性室性期前收縮患者交感神經(jīng)增強更明顯。2日間型為主的非器質(zhì)性室性期前收縮和夜間型為主的非器質(zhì)性室性期前收縮患者比較,夜間r MMSD指標數(shù)值顯著降低,主要與副交感神經(jīng)受損有關;3非器質(zhì)性室性期前收縮呈晝夜節(jié)律變化。隨著非器質(zhì)性室性期前收縮負荷的增高,室性期前收縮發(fā)生的次數(shù)也增加。4隨著非器質(zhì)性室性期前收縮負荷的增加,左室射血分數(shù)逐漸下降。高負荷的非器質(zhì)性室性期前收縮更易引起左室射血分數(shù)的降低。5日間型為主的非器質(zhì)性室性期前收縮和夜間型為主的非器質(zhì)性室性期前收縮對左心室功能的影響不大。
[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.
【學位授予單位】：承德醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.7
本文編號：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.
【學位授予單位】：承德醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.7
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