摘要
目的探讨心率变异性(heart rate variability,HRV)和心律失常发生率对急性肺栓塞(acute pulmonary embolism,APE)危险分层及预后评估的临床价值。方法回顾性分析100例经影像学检查确诊APE患者的临床资料。根据临床表现、简化肺栓塞严重指数、右心室功能不全和心肌损伤标志物水平等,将入选者分为高危组(33例)、中危组(41例)和低危组(26例)。确诊24 h内对各组进行24 h动态心电图检查,记录HRV指标(SDNN、SDANN、ASDNN)和心律失常发生率、不同类型心律失常检出率;同时,检测患者的NT-proBNP、D-二聚体水平,并将其与HRV指标、心律失常发生率进行单因素回归分析,确定影响APE危险分层的独立变量。结果高危组心律失常发生率显著高于中、低危组(P<0.05),中危组心律失常发生率显著高于低危组(P<0.05)。高危组的SDNN、SDANN、ASDNN较中、低危组均显著降低(P<0.05)。高危组的NT-proBNP、D-二聚体水平显著高于中、低危组(P<0.05)。有序多分类Logistic回归分析结果显示:室性心律失常、房室及束支传导阻滞、SDNN、NT-proBNP水平、D-二聚体水平为APE危险分层的独立因素(P<0.05)。结论HRV指标和心律失常发生率可作为APE危险分层的重要参考指标,HRV指标还可用于APE患者的预后评估。
Objective To explore the clinical value of heart rate variability(HRV)and the incidence of arrhythmia on the risk stratification and prognostic evaluation of acute pulmonary embolism(APE).Methods The clinical data of 100 APE patients admitted to our hospital were retrospectively analyzed.All of them had been diagnosed by imaging examination.According to the clinical manifestations,simplified pulmonary embolism severity index,right ventricular dysfunction and levels of myocardial injury markers,the enrolled patients were divided into high-risk group(33 cases),medium-risk group(41 cases),and low-risk group(26 cases).Within 24 hours after being diagnosed,patients of each group underwent 24-hour ambulatory electrocardiography examination,with HRV indexes including SDNN,SDANN and ASDNN,the incidence of arrhythmias,and the detection rate of various types of arrhythmias recorded.Meanwhile,the levels of NT-proBNP and D-dimer were tested,and made univariate regression analysis along with HRV indexes and the incidence of arrhythmias,so as to clarify the independent variables affecting the risk stratification of APE.Results The incidence of arrhythmia in high-risk group is significantly higher than that in medium-and low-risk group(P<0.05)while the incidence of arrhythmia in medium-risk group is significantly higher than that in low-risk group(P<0.05).The HRV indexes of SDNN,SDANN and ASDNN in high-risk group are significantly lower than those in medium-and low-risk group with statistically significant diffe-rences(P<0.05).The levels of NT-proBNP and D-dimer in high-risk group are significantly higher than those in medium-and low-risk group(P<0.05).The orderly multi-classified Logistic regression analysis shows that ventricular arrhythmia,atrioventricular and bundle branch block,SDNN,and NT-proBNP and D-dimer level are independent risk factors for the risk stratification of APE(P<0.05).Conclusion HRV indexes and the incidence of arrhythmia can be used as important reference indicators for making risk evaluation of APE,and the former can be applied in the prognostic evaluation of APE patients.
作者
万建平
杨伟烙
杨旭丽
杨泽福
宋势波
WAN Jianping;YANG Weiluo;YANG Xuli;YANG Zefu;SONG Shibo(Department of Electrophysiology,Nanhai District People s Hospital,Foshan Guangdong 528200,China)
出处
《实用心电学杂志》
2021年第1期32-36,共5页
Journal of Practical Electrocardiology
基金
佛山市科技计划项目(1920001000596)。
关键词
急性肺栓塞
动态心电图
心率变异性
心律失常
acute pulmonary embolism
ambulatory electrocardiography
heart rate variability
arrhythmia
