老年陈旧性脑梗死患者心率变异性及其干预与心脑血管并发症的影响研究
Relationship between Heart Rate Variability and the Effect of Intervention and Cardio-Cerebrovascular Complications in Elderly Patients with Old Cerebral Infarction
DOI: 10.12677/ACM.2023.1371597, PDF,   
作者: 赵 佳：青岛大学医学部，山东 青岛；陈 瞳, 耿凡琪, 王 燕, 张利方, 韩 迪*：青岛大学附属医院全科医学科，山东 青岛
关键词: 脑梗死；心率；自主神经系统；心脑血管并发症；Cerebral Infarction； Heart Rate； Autonomic Nervous System； Cardio-Cerebrovascular Complications
摘要: 目的：探讨老年陈旧性脑梗死患者心率变异性(HRV)及其干预对心脑血管并发症的关系。方法：回顾性筛选2018年1月至2022年1月于青岛大学附属医院住院的老年陈旧性脑梗死患者239例；根据出院是否长期接受β受体阻滞剂治疗分为特殊治疗组103例，常规治疗组136例，比较两组用药1年后的HRV各指标及心脑血管并发症的差异，采用Kaplan-Meier法绘制不同治疗方案陈旧性脑梗死患者的生存曲线，采用Cox比例风险回归分析探究陈旧性脑梗死患者心脑血管并发症的影响。结果：特殊治疗组患者治疗前后比较显示，时域指标HRV时域参数R-R间期标准差(SDNN)、RR间期标准差的平均值(SDNN index)、相邻RR间期差值的均方根(RMSSD)及频域指标高频功率HF均升高(P < 0.05)，频域指标低频功率/高频功率(LF/HF)降低(P < 0.05)；治疗后特殊治疗组与常规治疗组患者比较显示，时域指标SDNN、RR间期平均值的标准差(SDANN)、SDNN index、相邻RR间期>50 ms心搏数占总心搏次数的百分比(pNN50)、及频域指标HF均升高(P < 0.05)，频域指标(LF/HF)降低(P < 0.05)；特殊治疗组心脑血管并发症总发生率较常规治疗组降低(P < 0.05)。在老年陈旧性脑梗死患者中，特殊治疗组OS优于常规治疗组患者(χ2 = 5.509, P = 0.019)。多因素Cox回归分析显示，SDNN、SDANN、PNN50、是否给予β受体阻滞剂治疗是老年陈旧性脑梗死患者心脑血管并发症的影响因素(P < 0.05)。结论：陈旧性脑梗死患者仍存在HRV降低，自主神经功能障碍，给予陈旧性脑梗死患者调节自主神经功能的药物，仍可预防心脑血管不良事件，改善卒中预后。其中，SDNN、SDANN、PNN50是老年陈旧性脑梗死患者发生心脑血管并发症的独立影响因素。
Abstract: Objective: To investigate the relationship between heart rate variability (HRV) and cardio-cere- brovascular complications in elderly patients with old cerebral infarction (SPCI). Methods: A total of 239 elderly patients with old cerebral infarction who were hospitalized in Affiliated Hospital of Qingdao University from January 2018 to January 2022 were retrospectively selected. All patients were divided into 2 groups, the special treatment group (n = 103) and the traditional treatment group (n = 136), according to whether they received special treatment after discharge. The differ-ences of cardio-cerebrovascular complications after one year were compared between the two groups. Kaplan-Meier method was used to draw the survival curve of patients with old cerebral in-farction. Under different treatment schemes, Cox proportional risk regression analysis was used to explore the influence of cardio-cerebrovascular complications in patients with old cerebral infarc-tion. Results: The comparison before and after treatment in the special treatment group showed that the HRV time-domain SDNN, SDNN index, RMSSD and HF were all increased (P < 0.05), while LF/HF in the frequency domain was decreased (P < 0.05). After treatment, compared with the spe-cial treatment group and the traditional treatment group showed that HRV time-domain index SDNN, SDANN, SDNN index, PNN50 and frequency domain index HF were all increased (P < 0.05), the frequency domain index (LF/HF) was decreased (P < 0.05). The total incidence of cardio-cere- brovascular complications in the special treatment group was lower than that in the traditional treatment group (P < 0.05). In the elderly patients with old cerebral infarction, the OS in the special treatment group was better than that in the traditional treatment group (χ2 = 5.509, P = 0.019). Multivariate Cox regression analysis showed that SDNN, SDANN, PNN50 and β-blocker therapy were influencing factors of cardio-cerebrovascular complications in elderly patients with old cerebral in-farction (P < 0.05). Conclusion: The HRV still has be decreased in elderly patients with old cerebral infarction, and the autonomic nervous function is continuously impaired after cerebral infarction. Drugs to regulate autonomic nervous function in old cerebral infarction can still prevent car-dio-cerebrovascular adverse events and improve the prognosis of stroke. The SDNN, SDANN and PNN50 are independent influencing factors of cardio-cerebrovascular complications in elderly pa-tients with sequelae stage of cerebral infarction.
文章引用：赵佳, 陈瞳, 耿凡琪, 王燕, 张利方, 韩迪. 老年陈旧性脑梗死患者心率变异性及其干预与心脑血管并发症的影响研究[J]. 临床医学进展, 2023, 13(7): 11423-11432. https://doi.org/10.12677/ACM.2023.1371597

参考文献

[1] 王拥军, 李子孝, 谷鸿秋, 等. 中国卒中报告2020(中文版) (1) [J]. 中国卒中杂志, 2022, 17(5): 433-447.
[2] 范海青, 韩海燕, 王伟芳, 等. 中药离子导入联合常规康复训练治疗缺血性脑卒中的效果[J]. 中国临床研究, 2021, 34(11): 1581-1583.
[3] Sposato, L.A., Hilz, M.J., Aspberg, S., et al. (2020) Post-Stroke Cardiovascular Complications and Neurogenic Cardiac Injury: JACC State-of-the-Art Review. Journal of the American College of Cardiology, 76, 2768-2785. [Google Scholar] [CrossRef] [PubMed]
[4] 李京秀, 章富君, 刘娴, 等. 心率变异性的机制及其与心血管疾病的相关性研究进展[J]. 实用心电学杂志, 2021, 30(4): 293-296.
[5] Jimenez-Ruiz, A., Racosta, J.M., Kimpinski, K., Hilz, M.J. and Sposato, L.A. (2021) Cardiovascular Autonomic Dysfunction after Stroke. Neurological Sciences, 42, 1751-1758. [Google Scholar] [CrossRef] [PubMed]
[6] De Raedt, S., De Vos, A. and De Keyser, J. (2015) Autonomic Dysfunction in Acute Ischemic Stroke: An Underexplored Therapeutic Area? Journal of the Neurological Sciences, 348, 24-34. [Google Scholar] [CrossRef] [PubMed]
[7] Carandina, A., Lazzeri, G., Villa, D., et al. (2021) Targeting the Autonomic Nervous System for Risk Stratification, Outcome Prediction and Neuromodulation in Ischemic Stroke. International Journal of Molecular Sciences, 22, Article 2357. [Google Scholar] [CrossRef] [PubMed]
[8] Tobaldini, E., Sacco, R.M., Serafino, S., et al. (2019) Cardiac Auto-nomic Derangement is Associated with Worse Neurological Outcome in the very Early Phases of Ischemic Stroke. Jour-nal of Clinical Medicine, 8, Article 852. [Google Scholar] [CrossRef] [PubMed]
[9] Tang, S.C., Jen, H.I., Lin, Y.H., et al. (2015) Complexity of Heart Rate Variability Predicts Outcome in Intensive Care Unit Admitted Patients with Acute Stroke. Journal of Neurology, Neuro-surgery & Psychiatry, 86, 95-100. [Google Scholar] [CrossRef] [PubMed]
[10] 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国各类主要脑血管病诊断要点2019[J]. 中华神经科杂志, 2019, 52(9): 710-715.
[11] Rupprecht, S., Finn, S., Hoyer, D., Guenther, A., Witte, O.W., Schultze, T. and Schwab, M. (2020) Association between Systemic Inflamma-tion, Carotid Arteriosclerosis, and Autonomic Dysfunction. Translational Stroke Research, 11, 50-59. [Google Scholar] [CrossRef] [PubMed]
[12] Yoo, H.J., Thayer, J.F., Greening, S., et al. (2018) Brain Struc-tural Concomitants of Resting State Heart Rate Variability in the Young and Old: Evidence from Two Independent Sam-ples. Brain Structure and Function, 223, 727-737. [Google Scholar] [CrossRef] [PubMed]
[13] 王一萌, 王焕霞, 邱妍妍, 等. 高血压前期患者动态心电图心率减速力、心率变异性检测及相关性分析[J]. 中华医学杂志, 2019, 99(47): 3741-3742.
[14] Bassi, D., Cabiddu, R., Mendes, R.G., et al. (2018) Effects of Coexistence Hypertension and Type II Diabetes on Heart Rate Variability and Cardiorespiratory Fitness. Arquivos Brasileiros de Cardiologia, 111, 64-72. [Google Scholar] [CrossRef] [PubMed]
[15] Fyfe-Johnson, A.L., Muller, C.J., Alonso, A., et al. (2016) Heart Rate Variability and Incident Stroke: The Atherosclerosis Risk in Communities Study. Stroke, 47, 1452-1458. [Google Scholar] [CrossRef] 
[16] 杨玉青, 王欣彤, 江磊磊, 等. 急性缺血性脑卒中心率变异性降低相关因素分析[J]. 东南国防医药, 2022, 24(3): 248-252.
[17] Mayerl, C., Lukasser, M., Sedivy, R., Nie-deregger, H., Seiler, R. and Wick, G. (2006) Atherosclerosis Research from Past to Present—On the Track of Two Pathologists with Opposing Views, Carl von Rokitansky and Rudolf Virchow. Virchows Archiv, 449, 96-103. [Google Scholar] [CrossRef] [PubMed]
[18] Amiya, E., Watanabe, M. and Komuro, I. (2014) The Relationship between Vascular Function and the Autonomic Nervous System. Annals of Vascular Diseases, 7, 109-119. [Google Scholar] [CrossRef] [PubMed]
[19] Battaglini, D., Robba, C., Lopes, D.S.A., et al. (2020) Brain-Heart Interaction after Acute Ischemic Stroke. Critical Care, 24, Article No. 163. [Google Scholar] [CrossRef] [PubMed]
[20] Nayani, S., Sreedharan, S.E., Namboodiri, N., et al. (2016) Au-tonomic Dysfunction in First Ever Ischemic Stroke: Prevalence, Predictors and Short Term Neurovascular Outcome. Clinical Neurology and Neurosurgery, 150, 54-58. [Google Scholar] [CrossRef] [PubMed]
[21] Tobaldini, E., Proserpio, P., Oppo, V., et al. (2020) Cardiac Autonomic Dynamics during Sleep Are Lost in Patients with TIA and Stroke. Journal of Sleep Research, 29, e12878. [Google Scholar] [CrossRef] [PubMed]
[22] Grilletti, J., Scapini, K.B., Bernardes, N., et al. (2018) Impaired Baroreflex Sensitivity and Increased Systolic Blood Pressure Variability in Chronic Post-Ischemic Stroke. Clinics, 73, e253. [Google Scholar] [CrossRef] [PubMed]
[23] Dütsch, M., Burger, M., Dörfler, C., Schwab, S. and Hilz, M.J. (2007) Cardiovascular Autonomic Function in Poststroke Patients. Neurology, 69, 2249-2255. [Google Scholar] [CrossRef] [PubMed]
[24] Wang, R., Kohrmann, M., Kollmar, R., Koehn, J., Schwab, S., Kallmünzer, B. and Hilz, M.J. (2022) Cardiovascular Medication Seems to Promote Recovery of Autonomic Dysfunction after Stroke. Journal of Neurology, 269, 5454- 5465. [Google Scholar] [CrossRef] [PubMed]
[25] Bieber, M., Werner, R.A., Tanai, E., et al. (2017) Stroke-Induced Chronic Systolic Dysfunction Driven by Sympathetic Overactivity. Annals of Neurology, 82, 729-743. [Google Scholar] [CrossRef] [PubMed]
[26] Goyagi, T., Kimura, T., Nishikawa, T., et al. (2006) β-Adrenoreceptor An-tagonists Attenuate Brain Injury after Transient focal Ischemia in Rats. Anesthesia & Analgesia, 103, 658-663. [Google Scholar] [CrossRef] [PubMed]
[27] 卢俏丽, 徐梅松, 王欢, 等. 老年脑梗死患者神经功能缺损评分与心率变异性及心脏并发症的相关性研究[J]. 中华老年医学杂志, 2019, 38(12): 1339-1340.
[28] Sykora, M., Siarnik, P., Diedler, J., et al. (2015) β-Blockers, Pneumonia and Outcome after Ischemic Stroke: Evidence from Virtual International Stroke Trials Archive. Stroke, 46, 1269-1274. [Google Scholar] [CrossRef] 
[29] Ay, I., Sorensen, A.G. and Ay, H. (2011) Vagus Nerve Stimulation Reduces Infarct Size in Rat Focal Cerebral Ischemia: An Unlikely Role for Cerebral Blood Flow. Brain Re-search, 1392, 110-115. [Google Scholar] [CrossRef] [PubMed]
[30] Meyers, E.C., Solorzano, B.R., James, J., et al. (2018) Vagus Nerve Stimulation Enhances Stable Plasticity and Generalization of Stroke Recovery. Stroke, 49, 710-717. [Google Scholar] [CrossRef] 
[31] Francisco, G.E., Engineer, N.D., Dawson, J., et al. (2023) Vagus Nerve Stimulation Paired with Upper-Limb Rehabilitation after Stroke: 2- and 3-Year Follow-Up from the Pilot Study. Archives of Physical Medicine and Rehabilitation. (Article In Press) [Google Scholar] [CrossRef] [PubMed]
[32] Zhao, M., Guan, L. and Wang, Y. (2019) The Association of Au-tonomic Nervous System Function with Ischemic Stroke, and Treatment Strategies. Frontiers in Neurology, 10, Article 1411. [Google Scholar] [CrossRef] [PubMed]
[33] Mo, J., Huang, L., Peng, J., Ocak, U., Zhang, J. and Zhang, J.H. (2019) Autonomic Disturbances in Acute Cerebrovascular Disease. Neuroscience Bulletin, 35, 133-144. [Google Scholar] [CrossRef] [PubMed]
[34] Maier, I.L., Karch, A., Mikolajczyk, R., et al. (2015) Effect of β-Blocker Therapy on the Risk of Infections and Death after Acute Stroke—A Historical Cohort Study. PLOS ONE, 10, e116836. [Google Scholar] [CrossRef] [PubMed]
[35] von Rennenberg, R., Krause, T., Herm, J., et al. (2021) Heart Rate Variability and Recurrent Stroke and Myocardial Infarction in Patients with Acute Mild to Moderate Stroke. Fron-tiers in Neurology, 12, Article 772674. [Google Scholar] [CrossRef] [PubMed]

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