Objective To assess the changes of cardiac autonomic nerves’s function in patients underwent bronchofiberscopy by observing the dynamic electrocardiogram ( DCG) and heart rate variability ( HRV) , and investigate the effect of different preoperative medications on heart function.Methods Eighty patients underwent bronchofiberscopy were randomly divided into three groups according to different anaesthesia. Group A ( n =30) were local anaesthetized by nebulized lidocaine, group B ( n = 30) received atropine 1 mg injection intramuscularly and nebulized lidocaine, group C ( n = 20) were anaesthetized bypropofol intravenously. The DCG and HRV of three groups were mornitored at pre-inductive point( T0 ) , post inductive point ( T1 ) , point during the operation ( T2 ) , and point after operation ( T3 ) .Results The incidences of ST-T change, tachycardia, and bearing premature in group A and B were increased. The incidence of tachycardia in group C was also increased, but lower than group A and B while the ST-T change and bearing premature were milder ( P lt;0. 05) . Episodes of bradycardia occurred 3 times in group A andnone in group B and C ( P lt;0. 01) . The low-frequency ( LF) , high-frequency ( HF) , total power ( TP) in group A and B were raised, but the LF was highly raised, and the LF/HF and HRV significantly decreased.The LF/HF and HRV decreased lightly in group C ( P gt; 0. 05) . Conclusions Bronchofiberscopy examination can decrease HRV and induce arrhythmia and ST-T change, but also excite vagus nerve. Atropine can inhibit the excitability of vagus nerve and have no influence on HRV. The propofol may obviously decrease the sympathetic nervous activation, balance sympathetic and vagus nerves, which is beneficial to the stability of hemodynamics.
目的 探讨冠状动脉钙化检测联合动态心电图对冠心病的诊断价值及临床应用。 方法 对2010年5月－2011年8月住院的108例拟诊冠心病的患者同期进行128排螺旋CT冠状动脉钙化积分检测、动态心电图和冠状动脉造影，对比研究冠状动脉钙化检测联合动态心电图预测冠心病的价值。 结果 冠状动脉钙化阳性预测冠心病的灵敏度、特异度、阳性预测值和阴性预测值分别为75.6%、81.0%、73.9%、82.3%；动态心电图阳性预测冠心病的灵敏度、特异度、阳性预测值和阴性预测值分别为73.3%、76.2%、68.8%、80.0%；冠状动脉钙化检测联合动态心电图的系列实验的特异度和阳性预测值分别达到96.8%和92.9%，平行试验的灵敏度和阴性预测值分别达到93.3%和92.7%，均显著高于单项试验的相应指标（P＜0.05）。 结论 高分辨率螺旋CT冠状动脉钙化检测联合动态心电图显著提高冠心病的诊断价值，可作为老年患者及基层医院冠心病首选的筛选检查。
目的:了解阻塞性睡眠呼吸暂停综合征患者的心率变异改变。方法:对67例睡眠打鼾患者同步进行24小时动态心电图及多导睡眠图监测。根据PSG检测结果分为OSAS组和单纯鼾症组,比较组间低频峰(LF),高频峰(HF),低频峰与高频峰的比值(LF/HF),正常RR间期平均值及其标准差值(SDNN),正常RR间期差值均方根(rMSSD)。结果:OSAS组中,频域分析指标:LF,HF,均低于单纯鼾症组,LF/HF高于对照组,时域分析指标:SDNN,rMSSD均低于对照组。结论:OSAHS患者心率变异性降低。
目的:了解阻塞性睡眠呼吸暂停综合症(OSAHS)患者夜间心律失常的发生情况、常见类型及相关因素。方法:对67例睡眠打鼾患者同步进行动态心电图及多导睡眠图监测。以呼吸暂停指数及夜间最低氧饱和度将研究对象进行分组,比较分析夜间心律失常发生率及发生类型并进一步分析夜间心律失常的相关因素。结果:OSAS组的夜间心律失常发生率显著高于单纯鼾症患者。随着OSAS加重,呼吸暂停低通气指数逐渐增大,夜间氧饱和度下降越明显,心律失常发生率升高,发生时间延长、恶性程度增加,尤其以缓慢型心律失常的发生率增多。结论:OSAHS患者夜间心律失常的发生率及严重程度与OSAHS严重程度呈正相关,夜间心律失常的诱发与呼吸暂停低通气指数及低氧血症密切相关。应重视夜间心律失常患者合并存在的OSAHS的诊治。
目的:探讨动态心电图对无症状心肌缺血的诊断价值。方法:对138例冠心病(CHD)患者行24 h动态心电图检测。结果:共检出缺血型ST-T改变102例、723阵次。其中,无症状性心肌缺血562阵次(77.7%),发作时间高峰在6:00～11:00。结论:动态心电图是检测无症状心肌缺血的重要方法,对其病情的判断及早期防治具有重要的意义。
ObjectiveTo investigate the correlation between intima-media thickness (IMT) of carotid artery in color ultrasonography and the heart rate variability. MethodsA retrospective analysis was performed in 64 patients from West China Hospital of Sichuan University between March and May 2013. Carotid intima-media thickness was measured with color ultrasonography and dynamic electrocardiogram, and the heart rate variability was assayed at the same time. ResultsIMT in the cardiovascular disease group, combination group, coronary heart disease group and hypertension group was significantly thicker than the control group (P<0.05). The differences of SDNN and SDANN were statistically significant (P<0.05) between the combination group and the control group. There were 23 cases with IMT ≥ 1.0 mm in the cardiovascular disease group including 8 cases in the combination group, 10 cases in the coronary heart disease group and 5 cases in the hypertension group. IMT in those groups were all significantly higher than that in the control group with only 2 cases having IMT ≥ 1.0 mm (P<0.05). There were 18 cases with SDNN<100 ms in the cardiovascular disease group including 7 cases in the combination group, 6 cases in the coronary heart disease group and 5 cases in the hypertension group, but there was no statistically significant difference compared with that in the control group with only 11 cases (P>0.05). Negative correlation was found between IMT and SDNN, SDANN in the cardiovascular diseases group (r=-0.574, -0.544; P<0.01) and negative correlation was found between IMT and SDANN in the control group (r=-0.392, P<0.05). ConclusionThe carotid artery lesions and autonomic nerve especially sympathetic nerve dysfunction are obvious in patients with cardiovascular diseases and there is a negative correlation between them.
Lorenz plot (LP) method which gives a global view of long-time electrocardiogram signals, is an efficient simple visualization tool to analyze cardiac arrhythmias, and the morphologies and positions of the extracted attractors may reveal the underlying mechanisms of the onset and termination of arrhythmias. But automatic diagnosis is still impossible because it is lack of the method of extracting attractors by now. We presented here a methodology of attractor extraction and recognition based upon homogeneously statistical properties of the location parameters of scatter points in three dimensional LP (3DLP), which was constructed by three successive RR intervals as X, Y and Z axis in Cartesian coordinate system. Validation experiments were tested in a group of RR-interval time series and tags data with frequent unifocal premature complexes exported from a 24-hour Holter system. The results showed that this method had excellent effective not only on extraction of attractors, but also on automatic recognition of attractors by the location parameters such as the azimuth of the points peak frequency (APF) of eccentric attractors once stereographic projection of 3DLP along the space diagonal. Besides, APF was still a powerful index of differential diagnosis of atrial and ventricular extrasystole. Additional experiments proved that this method was also available on several other arrhythmias. Moreover, there were extremely relevant relationships between 3DLP and two dimensional LPs which indicate any conventional achievement of LPs could be implanted into 3DLP. It would have a broad application prospect to integrate this method into conventional long-time electrocardiogram monitoring and analysis system.