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目的探讨宫内窘迫胎儿出生后心率变异性(HRV)的变化特点及其临床意义。方法有宫内窘迫史的106例新生儿,根据Apgar评分分为无窒息组30例、轻度窒息组46例、重度窒息组30例,另选无宫内窘迫史的正常足月新生儿30例作对照组,于生后24 h内行动态心电图检查并分析心率变异性。结果无窒息组、轻度窒息组和对照组平均心率、最慢心率、最快心率比较,差异无统计学意义(P>0.05),重度窒息组3项指标均低于无窒息组、轻度窒息组及对照组(P<0.05)。无窒息组全部窦性心率R-R间期标准差、R-R间期均值的标准差、R-R间期标准的均值、相邻R-R间期差值的均方根、相邻R-R间期差值>50 ms心搏数的百分比与对照组相比,差异无统计学意义(P>0.05);无窒息组、轻度窒息组上述5项指标均高于重度窒息组(P<0.05)。结论宫内窘迫胎儿出生后无窒息表现的新生儿HRV指标在正常范围内,而窒息新生儿HRV指标存在不同程度降低,且窒息程度越重HRV指标越低。
Objective To investigate the changes of heart rate variability (HRV) after fetal distress in fetus and its clinical significance. Methods 106 neonates with history of intrauterine distress were divided according to Apgar score into 30 cases without asphyxia group, 46 cases with mild asphyxia group and 30 cases with severe asphyxia group. The normal full-term newborns without history of intrauterine distress Cases of control group, within 24 hours after birth, dynamic ECG and analysis of heart rate variability. Results No significant difference was found in the average heart rate, the slowest heart rate and the quickest heart rate between the asphyxia group, the mild asphyxia group and the control group (P> 0.05). The three indexes of severe asphyxia group were lower than those without asphyxia group, Asphyxia group and control group (P <0.05). The standard deviation of RR interval, the standard deviation of RR interval mean, the mean of RR interval standard, the root mean square of the difference between adjacent RR intervals, the difference of RR interval between adjacent RRs> 50 ms The percentage of heart rate was not significantly different from that of the control group (P> 0.05). The above five indexes in no asphyxia group and mild asphyxia group were higher than those in severe asphyxia group (P <0.05). Conclusions The neonatal HRV index without asphyxia after birth in fetus with intrauterine distress is within the normal range, while HRV indexes in asphyxia neonates are reduced to some extent, and the more asphyxia is, the lower the HRV index is.