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目的探讨房间隔缺损(ASD)经导管封堵术对心率变异性(HRV)的影响及意义。方法选择成功接受介入治疗的ASD患者118例为研究对象(ASD组),分别于术前1天及术后第4天记录24h动态心电图,由电脑自动分析并经心电专业人员校正,得出HRV的各项时域指标;另按术前心脏超声测得的肺循环血流量/体循环血流量(Qp/Qs)分为Ⅰ组(Qp/Qs<1.5)与Ⅱ组(Qp/Qs≥1.5),分析两亚组患者HRV,并行Qp/Qs与HRV的相关性分析。结果与对照组比较,ASD组封堵术前后24hRR间期标准差(SDNN)及24h内每5min节段RR间期均值标准差(SDANN)均显著降低(P<0.01或0.05);Ⅱ组降低更明显。ASD组封堵术后RR间期、SDNN及SDANN均较术前增加(P<0.05);Ⅱ组介入治疗术后的SDNN、ASDNN较Ⅰ组术后明显减小(P<0.05)。ASD患者术前SDNN及SDANN与Qp/Qs呈负相关(r值分别为-0.528、-0.644,P<0.01)。结论ASD封堵术后HRV水平明显恢复;Qp/Qs越大的ASD患者不仅术前HRV水平降低更显著,术后的恢复也越慢。
Objective To investigate the effect and significance of transcatheter closure of atrial septal defect (ASD) on heart rate variability (HRV). Methods A total of 118 patients with ASD who were successfully treated with interventional therapy were selected as the study group (ASD group). 24h dynamic electrocardiogram (ECG) was recorded at 1 day before surgery and 4 days after surgery. The results were automatically analyzed by computer and corrected by ECG professionals. (Qp / Qs <1.5) and group Ⅱ (Qp / Qs≥1.5) according to preoperative cardiac echocardiography, , Analysis of two subgroups of patients with HRV, parallel Qp / Qs and HRV correlation analysis. Results Compared with the control group, SDNN of 24hRR before and after closure in ASD group and SDANN of RR interval were significantly decreased (P <0.01 or 0.05) Reduce the more obvious. In the ASD group, RR interval, SDNN and SDANN were significantly increased after PCI (P <0.05). SDNN and ASDNN in group Ⅱ were significantly lower than those in group Ⅰ after PCI (P <0.05). There was a negative correlation between SDNN, SDANN and Qp / Qs before ASD (r = -0.528, -0.644, P <0.01, respectively). Conclusions The level of HRV in patients with ASD is recovered obviously. The patients with higher Qp / Qs ASD not only have a significant reduction of preoperative HRV but also have a slower recovery after operation.