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目的评价短时非线性的心率变异性指标在不同心功能分级的慢性心力衰竭患者中的变化及影响因素。方法应用5 min动态心电图分析84例慢性心力衰竭患者的心率变异性(HRV),非线性指标包括滑动窗口测度熵(MwEn)、中心边缘比(CER)、累积能量(CE),线性指标包括极低频功率(VLF)、低频功率(LF)、高频功率(HF)、低频功率/高频功率(LF/HF)、总功率(TP)、低频功率的标化值(LFn)、高频功率的标化值(HFn);用彩色多普勒超声诊断仪测定左室射血分数(LVEF)。将心率变异性指标与41例健康者进行比较,并分析非线性指标的影响因素。结果短时非线性心率变异性指标在不同心功能分级组间的差异存在统计学意义(P<0.05),在年龄、心率及LVEF三项指标中,LVEF是影响MwEn(r=0.50,P<0.001)、CER(r=-0.27,P=0.007)、CE(r=-0.30,P=0.003)的主要因素。结论短时非线性心率变异性分析可用来评价慢性心力衰竭患者的心功能状态,且与线性指标相比,具有较强敏感性。
Objective To evaluate the changes and influencing factors of short-term non-linear heart rate variability in patients with chronic heart failure with different cardiac function classification. Methods The heart rate variability (HRV) of 84 patients with chronic heart failure was analyzed by 5-minute ambulatory electrocardiogram (ECG). The nonlinear indices included sliding window entropy (MwEn), center margin ratio (CER) and cumulative energy (CE) VLF, LF, HF, LF / HF, TP, LFn, RF power, RF power, (HFn). Left ventricular ejection fraction (LVEF) was measured by color Doppler sonography. The heart rate variability index and 41 healthy people were compared, and the influencing factors of the non-linear index were analyzed. Results There were significant differences in short-term non-linear heart rate variability between groups with different cardiac function scores (P <0.05). Among the three indexes of age, heart rate and LVEF, LVEF was the effect of MwEn (r = 0.50, 0.001), CER (r = -0.27, P = 0.007) and CE (r = -0.30, P = 0.003) Conclusion Short-term non-linear analysis of heart rate variability can be used to assess cardiac function in patients with chronic heart failure, and compared with the linear indicators, with strong sensitivity.