影响心率变异因素的研究进展

临床医师和电生理学家早在1933年就注意到,健康人在静息状态下呈现ＲＲ间期的周期性变化,这种变化主要受呼吸、体位、压力感受器和温度调节的影响,并证实是通过影响交感和迷走神经活动来改变ＲＲ间期的周期性,正常人交感迷走神经保持一定的紧张度,互相制约,互相影响达到动态平衡,使成年人心率保持在60100ｂｐｍ,任何兴奋交感神经,减低迷走神经张力,抑制迷走神经反射的因素,都可使ＲＲ间期周期性变化减少,ＲＲ间期的微小变化称心率变异(ＨＲＶ)。ＨＲＶ作为反映神经体液因素对心血管精细调节的敏感指标,在临床具有很好的应用价值,众多的研究…     

心率变异研究进展

心率变异(HRV)是心脏节律变化-心律不齐的新描述,通常是指窦性心律在一定时间内周期性改变的现象。作为一项无创性、定量检测植物神经系统功能的手段,近年取得了许多新进展。 1 HRV的生理学基础 心血管活动受神经体液因素及自身因素的影响,心率是副交感神经系统与交感神经系统在窦房结水平相互作用的反映。正常人静息状态下,迷走神     

运动试验前后心率变异的对比分析

心率变异 (ＨＲＶ)分析是评价自主神经功能的无创性诊断方法 ,对心源性猝死有独立的预测价值[1 ] 。心电图运动负荷试验 (ＥＴ)作为检测心肌缺血的重要手段 ,其临床应用日益普及 ,并且更加广泛[2 ] 。我们对ＥＴ前后的ＨＲＶ测值进行了对比观察 ,以探讨其临床意义。1　资料与方法阳性组　ＥＴ检查结果阳性 (ＳＴ段较静息状态水平或下垂型再压低 1 0ｍｍ ,在Ｊ点后持续 80ｍｍ) ,患者 30 (男 1 6 ,女1 4 )例 ,年龄 37～ 63(51± 1 1 )岁。可疑阳性组ＥＴ结果 (ＳＴ段压低小于 1 0ｍｍ但大于 0 2ｍｍ) ,可疑阳性患者 30 (男 1 5 ,女1 5)例 …     

微信计步运动对老年女性心率变异的影响

目的探讨微信定量计步运动干预对缺乏运动老年女性心率变异的影响。方法征集老年女性,依据微信运动筛选出运动缺乏组及运动活跃组,比较两组心率变异指标的差异。对运动缺乏组进行12 w的微信定量计步运动干预,比较运动干预前后心率变异指标的差异。结果运动缺乏组与运动活跃组相比24 h正常窦性R-R间期值的标准差(SDNN)、心率变异性三角指数(TRI)及全程相禽R-R间期之差的均方根(rMSSD)指标均明显降低(P<0.05)。两组24 h内连续每5 min正常R-R间期平均值的标准差(SDANN)值无明显差异(P>0.05)。与运动前相比12 w的微信计步运动干预后运动缺乏组的老年女性心率变异的SDNN、TRI及rMSSD指标均明显升高(P<0.05)。结论运动缺乏的老年女性心率变异明显减低,微信定量计步运动干预可明显改善运动缺乏老年女性的心脏自主神经功能,提高心率变异性,改善心脏迷走神经张力。     

运动与心率变异

<正>心率变异性(HRV)是一种能有效评价人体内植物性神经功能状况的无创性指标〔1,2〕,具有高度敏感、可重复等特点。HRV有时又称为心率振荡或心率波动,分析时主要通过连续测量机体正常的心动周期变化,反映心率改变。本文对运动与HRV的研究进展进行综述。1 HRV的概念及测定方法1.1 HRV产生机制及研究意义HRV主要反映神经体液因素与窦房结相互的作用平衡关系,是用来评价神经体液对心血     

低血钾对心率变异的影响

目的 探讨低血钾对心率变异(HRV)的影响,将16例低血钾患者和15例健康受试者分成A、B2组,分别接受24h动态心电图(DCG)检查,并对2组检得的HRV时域指标(SDNN、SDANN、SDNNi、rMSSD、pNN50)进行比较分析。结果 低血钾组(A组)的SDNN、SDANN、SDNNi、rMSSD、pNN50均显著低于对照组(B组)(P<0.01)。结论 低血钾时HRV减小,心脏自主神经对心脏的调节功能下降。     

短程心率变异与长程心率变异对比分析

目的　探讨短程心率变异在临床应用的价值。方法　短程心率变异性测试采用床旁一分钟的测试方法 ,即受测试者佩带Holter记录盒后立即卧床 ,深呼吸 ,用心电图机连续描记一分钟的心电图 ,测试RR间期 ,如果RR间期所对应的快慢心率相差 10次以上为正常 ,低于或等于 10次为异常。结果　 (1)正常人短程心率变异性与高血压冠心病患者短程心率变异有显著差异 ;(2 )正常人长程心率变异时域指标分析与唐海沁等健康人心率变异时域法正常值分析结果相符 ;(3)短程与长程心率变异异常发生率无显著性差异 (P >0 0 5 )。     

老年高血压病患者运动血压和心率变异关系的初探

目的:探讨老年高血压病患者运动血压和心奉变异的关系。方法:入选血压控制良好的老年高血压病患者100例,分别给予踏车运动试验和24小时动态心电图测定心率变异(HRV)。按运动试验中最大运动量时收缩压(peakSBP)分为反应过高(A组)和反应正常(B组)2组,以运动停止6分钟后收缩压(recSBP)分为恢复慢(C组)和恢复正常(D组)2组,对比分析各组心率变异各指标的差异。结果:A组心率变异指标PNN 50,rMSSD,SDSD,SDNNI均显著高于B组(P<0.05或<0.01),多元逐步回归分析显示,peakSBP与SDNNI显著正相关(r=0.46)。C组与D组比较,心率变异各指标无统计学意义(P>0.05)。结论:老年高血压病运动血压过度升高可能与自主神经调节功能失调有关,其中SDNNI与peakSBP显著正相关,值得进一步研究。     

年龄及平均心率对心率变异指标的影响

为探讨年龄及平均心率对心率变异(HRV)的影响,观察心绞痛(n=66)、心肌梗塞(n=51)和正常人(n=75)3组对象短程体表心电图正常R-R间距之标准差(SD)及变异系数(CV)参数.结果表明多数情况下SD与平均心率显著负相关,而CV与平均心率的相关性较小.同时发现心绞痛及心肌梗塞组SD与年龄显著负相关(P<0.05),但CV与年龄无显著关系(P>0.05).故认为以CV作为HRV指标更能客观反映心脏自主神经功能状况.     

我国正常中老年人心率变异分析

心率变异分析（ＨｅａｒｔｒａｔｅｖａｒｉａｂｉｌｉｔｙＨＲＶ）目前被认为是一项预测心性猝死，特别是预测心肌梗死后病人猝死危险性的独立、敏感的指示。目前尚缺乏大样本ＨＲＶ时相分析正常值范围。本研究采用英国ＯＸＦＯＲＤ公司ＭｅｄｉｌｏｇＥＸＣＥＬ长程心电图分析系统，分别用标准差法（Ｓｔａｎｄａｒｄｄｅｖｉａｔｉｏｎ，ＳＤ）和ＨＲＶ指数法（ＨＲＶＩｎｄｅｘ）对１２０名（男：女＝９７：２３）４０一７０岁（平均５７岁，＜６０岁者６６人，≥６０岁者５４人）健康人的２４小时ＨＲＶ值进行测算。其结果为，ＳＤ：１１８．１５±１５．３７ｍｓ．ＨＲＶＩｎｄｅｘ１８．６２±２．３１；中年组（＜６０岁）平均ＳＤ：；１２２．０３ｍｓ．平均ＨＲＶＩｎｄｅｘ：２０．１６；老年组（≥６０岁）平均ＳＤ：１０７。９２ｍｓ．平均ＨＲＶＩｎｄｅｘ：１６．４１。两种方法的结果均显示。ＨＲＶ日间低于夜间，中年人高于老年人，３小时９时ＨＲＶ最低，与晨间冠心病急性发作事件高峰相吻合。本文并对ＨＲＶ的昼夜变化规律及其意义进行了初步探讨。     

Recovery of Heart Rate Variability and Ventricular Repolarization Indices Following Exercise

Background: There is a heightened risk of sudden cardiac death related to exercise and the postexercise recovery period, but the precise mechanism is unknown. We have demonstrated that sympathoexcitation persists for ≥45 minutes after exercise in normals and subjects with coronary artery disease (CAD). The purpose of this study is to determine whether this persistent sympathoexcitation is associated with persistent heart rate variability (HRV) and ventricular repolarization changes in the postexercise recovery period. Methods and Results: Twenty control subjects (age 50.7 ± 1.4 years), 68 subjects (age 58.2 ± 1.5 years) with CAD and preserved left ventricular ejection fraction (LVEF), and 18 subjects (age 57.6 ± 2.4 years) with CAD and depressed LVEF underwent a 16‐minute submaximal bicycle exercise protocol with continuous ECG monitoring. QT and RR intervals were measured in recovery to calculate the time dependent corrected QT intervals (QTc), the QT–RR relationship, and HRV. QTc was dependent on the choice of rate correction formula. There were no differences in QT–RR slopes among the three groups in early recovery. HRV recovered quickly in controls, more slowly in those with CAD‐preserved LVEF, and to a lesser extent in those with CAD‐depressed LVEF. Conclusion: Despite persistent sympathoexcitation for the 45‐minute recovery period, ventricular repolarization changes do not persist for that long and HRV changes differ by group. Additional understanding of the dynamic changes in cardiac parameters after exercise is needed to explore the mechanism of increased sudden cardiac death risk at this time.     

心率变异性的研究及应用进展

心率变异性是评价自主神经功能最常用的无创方法,随着计算技术的发展越来越多测量心率变异性的新方法进入到实践之中。自主神经系统在不同系统疾病中的影响和作用,正由于这种无创评估方法的实用化而被逐渐认识。现仅就心率变异性方法学和应用领域方面的进展进行简要概述。     

Interaction between Heart Rate and Heart Rate Variability

Heart rate variability (HRV) is significantly associated with average heart rate (HR), therefore, HRV actually provides information on two quantities, that is, on HR and its variability. It is difficult to conclude which of these two plays a principal role in the HRV clinical value, or in other words, what is the HR contribution to the clinical significance of HRV. Moreover, the association between HRV and HR is both a physiological phenomenon and a mathematical one. The physiological HRV dependence on HR is determined by the autonomic nervous system activity, but the mathematical one is caused by the nonlinear relationship between RR interval and HR. By employing modification methods of the HRV and HR relationship, it is possible to investigate the HR contribution to the HRV clinical value. Recent studies have shown that the removal of the HR impact on HRV makes HRV more predictive for noncardiac death, however, the enhancement of this impact causes HRV to be a better predictor of cardiovascular mortality. Thus, HR seems to constitute a cardiovascular factor of the HRV predictive ability. HR also influences the reproducibility of HRV, therefore, HR changes should be considered when one compares HRV measurements in a given patient. This review summarizes methodological aspects of investigations of the HRV and HR interaction as well as latest observations concerning its clinical utility. The issues discussed in this article should also refer to any other heart rate dynamics analysis which indices are significantly associated with HR.     

Heart Rate Variability in Heart Failure

The autonomic nervous system has an important role in the development and progression of the heart failure syndrome. Increased sympathetic, reduced parasympathetic, and impaired baroreceptor activity are well-documented features of heart failure. The analysis of heart rate variability can give insight into these autonomic abnormalities. A number of techniques now exist for assessing heart rate variability, and in general they reflect the known autonomic abnormalities. Power spectral analysis of RR variability has been claimed to reflect sympathovagal balance, but the reduced or absent low-frequency component in heart failure is paradoxical. It is likely that the absent low-frequency component in heart failure reflects impaired baroreceptor function. Although these various techniques of heart rate variability may be useful, reliability and reproducibility are problematic in this area. Better, more refined techniques for the noninvasive assessment of autonomic and baroreceptor function are still needed.     

Effects of Exercise Training on Heart Rate Variability in Chagas Heart Disease

Background:

Heart rate variability (HRV) is a marker of autonomic dysfunction severity. The effects of physical training on HRV indexes in Chagas heart disease (CHD) are not well established.

Objective:

To evaluate the changes in HRV indexes in response to physical training in CHD.

Methods:

Patients with CHD and left ventricular (LV) dysfunction, physically inactive, were randomized either to the intervention (IG, N = 18) or control group (CG, N = 19). The IG participated in a 12-week exercise program consisting of 3 sessions/week.

Results:

Mean age was 49.5 ± 8 years, 59% males, mean LVEF was 36.3 ± 7.8%. Baseline HRV indexes were similar between groups. From baseline to follow-up, total power (TP): 1653 (IQ 625 - 3418) to 2794 (1617 - 4452) ms, p = 0.02) and very low frequency power: 586 (290 - 1565) to 815 (610 - 1425) ms, p = 0.047) increased in the IG, but not in the CG. The delta (post - pre) HRV indexes were similar: SDNN 11.5 ± 30.0 vs. 3.7 ± 25.1 ms. p = 0.10; rMSSD 2 (6 - 17) vs. 1 (21 - 9) ms. p = 0.43; TP 943 (731 - 3130) vs. 1780 (921 - 2743) Hz. p = 0.46; low frequency power (LFP) 1.0 (150 - 197) vs. 60 (111 - 146) Hz. p = 0.85; except for high frequency power, which tended to increase in the IG: 42 (133 - 92) vs. 79 (61 - 328) Hz. p = 0.08).

Conclusion:

In the studied population, the variation of HRV indexes was similar between the active and inactive groups. Clinical improvement with physical activity seems to be independent from autonomic dysfunction markers in CHD.     

慢性心力衰竭病人的心率变异性及左旋甲状腺素钠的干预作用

目的 探讨慢性心力衰竭（CHF）病人心率变异性（HRV）的变化。研究HRV各指标与CHF类型、原发病、心功能关系及左旋甲状腺素钠（优甲乐）对CHF病人HRV的影响。方法 选择CHF病人114例，分为左心衰竭组、右心衰竭组、全心衰竭组，并以38名健康对照者进行比较。记录每位个病人治疗前的HRV、慢性心力衰竭类型、原发病、心功能。对CHF114例中低三碘甲状腺原氨酸（T3）的60例CHF病人随机分为两组，每组30例。对照组给予常规抗心力衰竭治疗，治疗组在常规抗心力衰竭治疗基础上加服优甲乐50ug／d，口服。治疗前和治疗3个月后分别测定两组病人的HRV指标并进行比较；出院后随访半年，记录再住院率、病死率。结果 CHF病人24h总的NN间期标准差（SDNN）、24h总的NN间期平均值的标准差（SDANN）较正常对照组降低，且随着CHF心功能程度的加重而逐渐降低；与左心衰竭组、右心衰竭组比较，全心衰竭组SDNN、SDANN降低（P〈0.01）。治疗3个月后，治疗组的SDNN、SDANN均较治疗前及对照组明显提高（P〈0．05）。结论 病人HRV部分指标变化可作为判定严重程度的参考指标。各项HRV指标变化大小可能与病人的原发病无关，但部分似与CHF类型、心功能程度有关。在常规抗心力衰竭治疗的基础上，加用优甲乐治疗CHF，可提高病人HRV，增强疗效，改善预后。