高海拔地区高原肺动脉高压藏族患者自主神经功能评测

›› 2019, Vol. 39 ›› Issue (12): 1717-1722.

高海拔地区高原肺动脉高压藏族患者自主神经功能评测

张前¹,范爱莉²,达娃²,达娃次仁²,潘彬彬²

1. 北京大学人民医院
2. 西藏自治区人民医院

收稿日期:2019-07-11 修回日期:2019-10-21 出版日期:2019-12-05 发布日期:2019-12-04
通讯作者: 张前 E-mail:zq201103@163.com

Assessment of autonomic nervous function in Tibetan patients with high altitude pulmonary hypertension

Received:2019-07-11 Revised:2019-10-21 Online:2019-12-05 Published:2019-12-04
Contact: qian ZHANG E-mail:zq201103@163.com

摘要/Abstract

摘要： 目的探讨高海拔地区高原肺动脉高压（HAPH）的藏族患者心率变异性（HRV ）变化。方法采用方便的抽样方法，选取2018年11月至2019年3月西藏自治区人民医院心脏病监护室的120例HAPH患者作为观察组；同时选择同期入院的50例无明确器质性疾病者为对照组。超声心动图估测肺动脉收缩压(PASP)，据此将肺动脉高压（PAH）者分为3组：轻度组PASP: 30～49 mm Hg(1mm Hg=0．133 kPa)；中度组PASP：50～69 mmHg；重度组PASP：≥70mmHg。对各组患者进行24 h动态心电图检查，以HRV指标［时域分析：全部窦性心搏RR间期（SDNN）、每5min正常RR间期平均值标准差（SDANN）、相邻RR间期差的均方根（RMSSD）、相差> 50 ms的相邻RR 间期占RR 间期总数百分比（PNN50)、HRVTI又称三角指数；频域分析：总频域值（TP）、极低频（VLF：0.03-0.04 Hz）、低频（LF：0.04-0.15 Hz）和高频（HF：0.15-0.40 Hz）]进行测定并分析比较。结果与对照组相比24h长程分析时域指标SDNN、SDANN、RMSSD、PNN50、HRVTI均明显降低（P<0.01）。短程分析频域指标包括总频域值（TP）、极低频（VLF）、低频（LF）和高频（HF）均明显降低（P<0.01）。但LF/HF在轻度肺动脉高压组最高，在中度肺动脉压组最低，组间差异明显（P<0.05）。结论西藏高海拔地区慢性高原性肺动脉高压患者心率变异性明显降低且与肺动脉压严重程度呈明显负相关。

关键词: 高海拔, 高原肺动脉高压, 自主神经系统, 心率变异性

Abstract: Objective To investigate the changes of heart rate variability (HRV) in Tibet patients with high altitude pulmonary hypertension (HAPH) . Methods From November 2018 to March 2019, 120 patients with HAPH in the cardiac care unit of the People's Hospital of Tibet Autonomous Region were selected as observation groups, and 50 patients without organic heart disease served as control groups. Pulmonary artery systolic pressure (PASP) was evaluated by Doppler ehocardiography in patients with PAH, according to which PAH is divided into three groups: mild group PASP: 30 ~ 49 mm Hg (1mmHg = 0.133 kPa); moderate group PASP: 50 ~ 69 mmHg Severity group PASP: ≥70mmHg. A 24-h dynamic electrocardiogram was performed on each group of patients.Heart rate variability index [Time domain : standard deviation of normal RR intervals (SDNN), standard deviation of 5 minutes average normal RR intervals (SDANN) , root mean square of sueeessive difference in RR interval (RMSSD), percentage of RR intervals differing more than 50ms from the preeding one (PNN50), HRVTI is also called triangle index; frequency domain: total power (TP), very low frequency (VLF: 0.03-0.04 Hz), low frequency (LF: 0.04-0.15 Hz) and high frequency (HF: 0.15-0.40 Hz) were measured and compared. Results Compared with the control group, the 24-hour long-range analysis time domain indicators SDNN, SDANN, RMSSD, PNN50, and HRVTI were significantly reduced (P<0.01). Short-term analysis of frequency domain indicators included in total frequency domain (TP), very low frequency (VLF), low frequency (LF), and high frequency (HF). These all showed a significant reduction (P<0.01) . However, LF/HF was the highest in the mild pulmonary hypertension group and the lowest in the moderate pulmonary arterial pressure group, and the difference between the groups was statistically significant. Conclusions The heart rate variability of patients with chronic high altitude pulmonary hypertension in high altitude areas in Tibet is significantly reduced relative to healthy controls. It is significantly negatively correlated with the severity of pulmonary artery pressure.

Key words: high altitude, high altitude pulmonary hypertension, autonomic nervous system, heart rate variability

张前范爱莉达娃达娃次仁潘彬彬. 高海拔地区高原肺动脉高压藏族患者自主神经功能评测[J]. , 2019, 39(12): 1717-1722.