韩君勇,黄达梅,周元植,张莉
HAN Jun yong; HUANG Da mei; ZHOU Yuan zhi; ZHANG Li (Department of Cardiovasology;

• 1:贵阳医学院附院心内科
• 2:贵阳医学院附院心内科
• 3:贵阳医学院附院心内科
• 4:贵阳医学院附院心内科 贵州贵阳550004

摘要(Abstract)：

目的 :观察血管紧张素转换酶抑制剂和 β 受体阻断剂用药前后冠心病患者心率变异性 (HRV)的变化 ,以探讨血管紧张素转换酶抑制剂和β 受体阻断剂对冠心病人HRV的影响及机理。方法 :将 93例冠心病人根据用药情况分为 3组 ,C1组 :服用消心痛 +阿司匹林 ;C2组 :服用消心痛 +阿司匹林 +卡托普利 ;C3组 ;服用消心痛 +阿司匹林 +倍他乐克 (或阿替洛尔 )。观察用药前后全天HRV变化。结果 :C1组用药前后R -R连续差异平方根 (rMSSD)、高频能谱 (HF ,ms2 )、低频能谱 (LFms2 )和LF/HF差异无显著意义 (P >0 0 5 )。C2组用药前后比较 ,rMSSD为 2 5 3 7± 11 87和 3 6 68± 12 2 3 ,HF为 170 78± 10 8 80和 196 3 4± 10 8 77,LF/HF为2 0 9± 1 3 7和 1 75± 1 0 6,rMSSD、HF试验后比试验前明显升高 ,差异有极显著意义 (P <0 0 1) ;LF/HF降低 ,差异有显著意义 (P <0 0 5 )。C3组用药前后rMSSD为 2 8 97± 11 71和 3 3 2 9± 10 77,HF为 15 5 3 1± 10 1 2 5和 2 14 42± 12 0 77,LF为 3 0 2 79± 2 11 2 4和 3 3 5 40± 2 0 8 82 ,LF/HF为 2 5 1± 1 62和 1 83± 1 2 2。rMSSD、HF在试验后比试验前明显升高 ,差异有极显著意义 (P <0 0 1) ;LF升高 ,差异有显著意义 (P <0 0 5 ) ;LF/HF明显降低 ,差?
Objective: We have observed the changes of heart rate variability (HRV) in patients with coronary artery disease before and afrer treatments in order to determine the effects of angiotensin-converting enzyme inhibitors (ACEI)and β-blocker on HRV. Methods: HRV in the whole day was assessed and HRV(rMSSD,LF,HF)was obtained from 93 patients with coronary artery disease before and after treatments. Of them 30 patients treated with sorbitrate and aspirin (group C1), 32 patients treated with sorbitrate, aspirin and captopril (group C2), and 31 patients treated with sorbitrate, aspirin and metoprdol or atenolol (group C3). Results: ACEI increased rMSSD from 25 37±11 87 to 36 68±12 23(P<0 01),HF from 170 78±108 80 to 196 34±108 77(P<0 01),decreased LF/HF from 2 09±1 37 to 1 75±0 06(P<0 05) after treatments in gruop C2 β-blocker increased rMSSD from 28 97±11 71 to 33 29 ±10 77, HF form 155 31±101 25 to 214 42±120 77(P<0 01),LF form 302 79 ±211 24 to 335 40 ± 208 82(P<0 05) and decreased LF/HF from 2 15±1 62 to 1 83±1 22(P<0 01)in group C3 The changes of HRV in group C1 were not statistically significant. Conclusion: ACEI and β- blocker could improve the balance of autonomic nervous activties in patients with coronary artery disease.

关键词(KeyWords)： 血管紧张素转换酶抑制剂;β受体阻断剂;冠状动脉疾病;心率变异性
angiotensin -converting enzyme inhibitors; β-blocker; coronary artery diseses; heart rate variability.

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 韩君勇,黄达梅,周元植,张莉
HAN Jun yong; HUANG Da mei; ZHOU Yuan zhi; ZHANG Li (Department of Cardiovasology;

DOI: 10.19367/j.cnki.1000-2707.2001.06.006

参考文献(References)：

• [1]JiunnL ,HsiaoLC ,ChaoCD ,etalLong-termβ-blockertherapyimprovesautonmicnervousregulationinadvancedcongestiveheartfailure:alongitudinalheartratevariablitystudyAMHeartJ,1999,137:658-665
• [2]徐军,翁新新,赵悦敏,等β-受体阻断剂和血管紧张素转换酶抑制剂对心肌梗死患者心率变异影响的比较.中国心脏起搏与心电生理杂志,1997,11(4):185-187
• [3]MalfattoG ,FacchiniM ,SalaL ,etalEffectofcardiacregabilitateandbetablockertherayonHRVafterfirstAMI AMJCardiol,1998,81(7):834-440.
• [4]NiemelaM ,MallianiA ,HuikuriHV ,etal.Efectofbetablockadeonheartratevariabilityinpatientswithcoronatyarterydisease.JAMCOLLCardiol,1994,23:1370.
• [5]刘亚荣,杨欣国.心率变异性在慢性心力衰竭诊治中的应用进展.心脏杂志,2000,12(2):128-130.
• [6]TheISIS -4CollaborativeGroup,InternationalstudyofInfarctSnrviva1-4.Arandomizedtrialassessingearlyo ralcaptopril,oralmonitrateandintravenousmagnesiumsulpatein58050 patientswithsuapected　acute　my ocardial　infarction.Lancet,1995,345:669.
• [7]张燕,张旭明,伍卫,等.依那普利对急性心肌梗死心率变异性、压力反射敏感性与心肌心电生理特性的影响.中华心血管病杂志,1999,27(5):394-396.
• [8]KontopoulosAG ,AthyrosVG ,PapageorigimAA ,etal.Effectofangitotensin-convertingenzymeinhibitesonthepowerspectrumofHRVinpost-myocardialinfarc tionpatients.CoronArteryDis,1997,8(8-9):517-524.
• [9]LickerM ,SchweizerA ,HohnL ,etal.CardiovascularresponsestoanestheticinpatientschronicallytreatedwithACEI.CanJAnaesth,2000,47(5):433-440.
• [10]ZhangYH ,SongTC ,ZhuJ ,etal.Effectofenalaprilonheartratevariabilityinpatientswithcongestiveheartfailure.AMJCardiol,1995,76:1045.

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