摘要 目的观察急性心肌梗死（AMI）患者心率变异性（HRV）的变化，分析减慢呼吸频率对AMI患者HRV的影响。方法试验分两组，AMI组31例，对照组34例，行24 h心电呼吸监测；AMI组行5 min 16次/min及减慢呼吸频率（8次/min）的呼吸调节。观察AMI对HRV的影响，减慢呼吸频率对HRV时域、呼吸峰及频域分析的影响，并校正呼吸峰移位对频域分析的影响。结果（1） AMI组SDNN、SDANN较对照组降低（P<0.01），SDNNin、rMSSD降低（P<0.05），差异均有统计学意义；其中AMI组SDNN<100 ms的比例明显高于对照组(P<0.01)，差异有统计学意义。（2） ① 减慢呼吸频率SDNN升高(P>0.05)，rMSSD升高（P<0.05）；呼吸峰左移至LF段（P<0.01），常规频域指标LF及LF/HF升高（P<0.01），HF降低（P<0.01）；② 校正减慢呼吸频率引起呼吸峰左移对频域分析的影响后，低频成分（LFa）降低（P<0.05），高频成分（HFa）升高（P<0.01），低高频比值(LFa/HFa)降低（P<0.01）。结论AMI 24 h HRV时域分析提示AMI可降低迷走神经兴奋性,AMI短时程频域及时域分析提示减慢呼吸频率使交感-迷走平衡移向迷走神经。在HRV频域分析中必须排除减慢呼吸频率对呼吸峰左移的影响。
Abstract：Objective To observe the changes of heart rate variability(HRV) in patients with acute myocardial infarction(AMI), and to analyze the influence of slowing breathing frequency on HRV of AMI patients. [WTHZ]Methods[WT]Experiment was carried out in two groups, with 31 cases in AMI group, and 34 in control group. All the enrolled patients underwent 24 hour monitoring of respiration and electrocardiogram. The breathing frequency of AMI group was regulated at 16 times/min and 8 times/min(slowing the breathing frequency) separately for 5 minutes. The influence of AMI on HRV was observed as well as the slowing of breathing frequency on HRV time domain, respiratory peak, and frequency domain analysis. The influence of respiratory peak shift on frequency domain analysis was adjusted. [WTHZ]Results[WT](i) In AMI group, SDNN and SDANN were lower than those of control group(P＜0.01), and so were SDNNin and rMSSD(P＜0.05), both with statistically significant differences. The proportion among AMI group with SDNN shorter than 100 ms was significantly higher than that in control group(P＜0.01), with statistically significant difference. (ii) With the slowing of breathing frequency, SDNN increased(P＞0.05), and rMSSD also increased(P＜0.05); respiratory peak shifted left to LF segment(P＜0.01) while routine frequency domain indices of LF and LF/HF both increased(P＜0.01), and HF decreased(P＜0.01). The slowing of breathing frequency resulted in the left shift of respiratory peak. After its impact on frequency domain analysis was corrected, low frequency component(LFa) decreased(P＜0.05), high frequency component(HFa) increased(P＜0.01), and the ratio(LFa/HFa) decreased(P＜0.01). [WTHZ]Conclusion[WT]Twenty-four hour HRV time domain analysis on AMI patients indicates that AMI can reduce the function of vagus nerve. Short duration analysis of frequency and time domain on AMI patients suggests that slowing of breathing frequency causes sympathetic vagal balance toward the vagus nerve and its influence on the left shift of respiratory peak should be excluded in HRV frequency domain analysis.
刘俊敏,刘仁光,沈仲元. 减慢呼吸频率对急性心肌梗死患者心率变异性的影响[J]. 实用心电学杂志, 2015, 24(4): 271-275.
刘俊敏,刘仁光,沈仲元. The influence of slowing breathing frequency on heart rate variability in patients with acute myocardial infarction. JOURNAL OF PRACTICAL ELECTROCARDIOLOGY, 2015, 24(4): 271-275.
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