氧疗对慢性阻塞性肺疾病患者心率变异性的影响

摘要

目的 探讨慢性阻塞性肺疾病患者的心率变异性的变化,氧疗对心率变异性的影响及其临床意义.方法 选择我院慢性阻塞性肺疾病缓解期患者162例,经肺功能检测分为Ⅰ级(1组)、Ⅱ级(2组)、Ⅲ级(3组)及Ⅳ级(4组),均行24h心率变异性监测,检查心率变异性时域指标:24h内窦性心搏RR间期的总体标准差(SDNN)、24h内连续每5min正常RR间期均值的标准差(SDANN)、24h连续每5min节段正常RR间期标准差(SDNN Index)、24h内相邻正常连续性RR间期差值的均方根(rMSSD),检查完后给予低流量(1～2L/min)鼻塞吸氧,每天吸氧时间12h以上,1周后再次行心率变异性检测.对比分析四组患者吸氧前后的SDNN、SDNN Index、SDANN、rMSSD的变化.结果 四组患者吸氧前后二氧化碳分压(PCO2)、氧分压(PO2)及pH均无统计学差异(P＞0.05).四组患者吸氧前,3、4组与1、2组各心率变异性指标比较,差异有统计学意义(P＜0.05),且随着COPD级别的加重,SDNN、SDNN Index、SDANN、rMSSD的数值有减小趋势;四组患者吸氧后SDNN、SDNN Index、SDANN、rMSSD较吸氧前升高,差异有统计学意义(P＜0.05).结论 随着慢性阻塞性肺疾病患者病情加重,心率变异性各时域指标下降,吸氧后心率变异性各指标较吸氧前升高,提示慢性阻塞性肺疾病患者存在自主神经功能损伤,氧疗可能减少自主神经功能的损伤.%Objective To explore the variety of heart rate variability (HRV) in patients with chronic obstructive pulmonary disease (COPD),and to study the influences of oxygen therapy to HRV and the clinical significance.Methods 162 patients with COPD during remission were enrolled in this study.They were divided into four groups according to the pulmonary function tests.They were the Ⅰ stage of COPD (group 1),the Ⅱ stage (group 2),the Ⅲ stage (group 3) and the Ⅳ stage (group 4).HRV was screened by the 24 hour holter monitor,including standard deviation of the normal-to-normal intervals (SDNN),standard deviation of the average normal-to-normal intervals (SDANN),SDNN index and square root of the mean squared differences of successive normal-to-normal intervals (rMSSD).A low flow of oxygen (1-2 L/min) was taken by all the patients at least 12 hours a day for 7 days.HRV was tested again after the oxygen therapy.All the HRV parameters of the four groups were compared before and after oxygen therapy.Results In time domain HRV parameters,SDNN,SDNN index,SDANN,rMSSD in group 1 were (115 ± 15,53 ± 13,101 ± 26,34 ± 11),SDNN,SDNN index,SDANN,rMSSD in group 2 were (108-± 13,46 ± 11,94 ± 24,31 ± 9),SDNN,SDNN index,SDANN,rMSSD in group 3 were (69 ± 18,31 ± 11,58 ± 23,22 ± 14),SDNN,SDNN index,SDANN,rMSSD in group 4 were (61 ± 14,28 ± 12,54 ± 21,19 ± 13).SDNN,SDNN index,SDANN,rMSSD in group were lower 3,4 than those in group 1,2.The differences were significant (P＜0.05).After oxygen treatment,the time domain HRV parameters of all the patients were higher than those before treatment,the differences were statistically significant (P＜0.05).After oxygen therapy,SDNN,SDNN Index,SDANN,rMSSD in group 1 were (130 ± 21,65 ± 15,119 ± 24,42 ± 14),SDNN,SDNN Index,SDANN,rMSSD in group 2 were (132 ± 18,61 ± 16,106 ± 18,38 ± 11),SDNN,SDNN Index,SDANN,rMSSD in group 3 were (102 ± 21,49 ± 13,74 ± 27,30 ± 11),SDNN,SDNN Index,SDANN,rMSSD in group 4 were (98 ± 19,37 ± 13,69 ± 23,27 ± 15).Conclusion The time domain HRV parameters decrease with aggravation of COPD.The HRV parameters increase after oxygen therapy.All these may imply that the function of autonomic nerve in COPD patients is impaired,and oxygen therapy may alleviate the damage.