老年不稳定型心绞痛伴消极心理患者的心率变异性分析

目的 研究老年不稳定型心绞痛伴消极心理患者的心率变异性及心律失常特点并观察治疗前后的变化.方法 年龄≥65岁冠心病不稳定型心绞痛患者80例,经综合医院焦虑抑郁量表(HAD)测定分为伴消极心理组36例,不伴消极心理组44例,给予Holter监测并分析其结果.结果 与不伴消极心理组相比,消极心理组患者24 h所有窦性心搏R-R间期的标准差(SDNN)、24 h每5分钟R-R间期平均值的标准差(SDANN)、24 h相邻R-R间期差值的均方根(rMSSD)、24 h相邻R-R间期差值＞50 ms的百分数(PNN50)、24 h每5分钟R-R间期标准差的平均值(SDNNindex)降低(86.8±14.1)、(138.9±37.2)ms,(78.1±11.2)、(123.3±32.5)ms,(22.9±4.5)、(25.7±12.3)ms,(6.3±1.2)%、(9.2±5.3)%,(40.3±16.4)、(47.8±10.7)ms,t值分别为4.20、2.52、2.32、2.28、2.20,P均＜0.05],室性心律失常、窦性心动过速、缺血性ST-T改变以及HRV减低的检出率升高55.56%(20/36)、9.09%(4/44),13.89%(5/36)、2.27%(1/44),33.33%(12/36)、6.82%(3/44),52.78%(19/36)、18.18%(8/44),x2值分别为16.89、4.18、4.33、4.99,P均＜0.05).消极心理组给予百忧解治疗前后SDNN、SDANN、rMSSD、PNN50、SDNNindex升高(84.7±34.0)、(102.1±29.6)ms、(79.2±39.6)、(94.2±26.7)ms,(23.4±7.5)、(35.6±10.2)ms,(5.1±2.1)%、(9.9±7.5)%,(38.1±11.8)、(63.3±13.8)ms,t值分别为3.60、2.43、2.34、2.26、2.30,P均＜0.05],消极心理组患者百忧解治疗后室性心律失常、窦性心动过速、缺血性ST-T改变及HRV减低的检出率降低,与治疗前相比差异均有统计学意义(x2值分别为5.58、4.33、4.24、4.06,P均＜0.05).结论 伴消极心理老年冠心病不稳定型心绞痛患者的HRV减低,并且易发生室性心律失常、窦性心动过速及缺血性ST-T改变,百忧解治疗可降低心律失常的发生,改善心肌缺血.

Analysis of heart rate variability in elderly patients with unstable angina pectoris and negative psychology

Objective To study the heart rate variability and arrhythmia characteristics in the elderly patients with unstable angina and negative psychology and to observe the changes before and after treatment. Methods Eighty patients aged ≥ 65 years with unstable angina were recruited in the study, and divided into two groups according to the determination of Hospital Anxiety and Depression Scale: 36 patients in the negative psychology group( NP group) and 44 in the non-negative psychology group ( non-NP group). All patients were monitored by Holter. Results The SDNN, SDANN, SDNNidex, rMSSD and PNN50 in the NP group were (86.8 ±14.1 ) ms, (78.1 ± 11.2 ) ms, (22.9 ± 4.5 ) ms, ( 6.3 ± 1.2 ) % and (40.3 ± 16.4) ms, respectively, which were significantly decreased compared to that in the non-NP group ( 138.9 ± 37.1 ) ms, ( 123.3 ± 32.5 ) ms, (25.7 ±12.3)ms,(9.2 ±5.3)% and (47.8 ± 10.7)ms,respectively] (t =4.20,2.52,2.32,2.28 and 2.20,Ps ＜0.05)The prevalence of ventricular arrhythmia, sinus tachycardia, ischemic ST-T changes and heart rate variability (HRV) (55.56%, 13.89%, 33. 33% and 52. 78%, respectively) significantly increased in the NP group,compared to those in the non-NP group(9.09% ,2.27% ,6.82%, 18.18% ,respectively) ( χ2 = 16.89,4.18,4.33 and 4.99, respectively, Ps ＜ 0.05 ). After treatment with Prozac ( fluoxetine hydrochloride scientific name), SDNN,SDANN,rMSSD,PNN50,SDNNindex significantly increased from (84.7 ± 34.0) ms, (79.2 ± 39.6) ms, (23.4 ±7.5)ms,(5.1 ±2.1)% and (38.1 ± 11.8)ms to (102. 1 ±29.6)ms,(94.2 ±26.7)ms,(35.6 ± 10.2)ms,(9.9 ± 7.5 ) % and (63.3 ± 13.8 ) ms ( t = 3.60,2.43,2.34,2.26 and 2.30, P ＜ 0.05 ). After treatment,ventricular arrhythmia,sinus tachycardia,ischemic ST-T changes and HRV significantly decreased compared to that before treatment in the NP group (χ2 = 5.58,4.33,4.24 and 4.06 ,P ＜ 0. 05 ). Conclusions In patients of coronary heart disease with unstable angina and negative psychologically , HRV decreased , and they are prone to ventricular arrhythmias,sinus tachycardia and ischemic ST-T changes. Treatment with Prozac could decrease arrhythmia and improve cardiac ischemia arrhythmias, sinus tachycardia and ischemic ST-T changes. Treatment with Prozac could decrease arrhythmia and improve cardiac ischemia.