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目的研究不同程度降压对老年高血压及合并腔隙性脑梗死患者心率变异性的影响,探讨高血压不同病理状态下HRV变化的差异。方法选择老年原发性高血压(高血压组)及合并腔隙性脑梗死(腔梗组)患者各33例为观察对象;同期健康老年人自愿者(健康对照组)27例,测定降压治疗前后不同血压水平下心率变异性参数的变化。结果降压治疗前高血压并脑梗组和高血压组心率变异性的各时域指标均较正常组明显减小,其中高血压并脑梗组较高血压组减小更明显,但2组比较仅SDNNI和RMSSD差异有统计学意义(P<0.05)。降压治疗后无论高血压组或高血压并脑梗组各时域指标均有不同程度的增高,第2次降压较第1次降压后各组各时域指标增高更明显。第1次降压后和降压前比较,各时域指标仅高血压组SDANNI和PNN50差异有统计学意义(P<0.05);第2次降压后和降压前比较,高血压组SDNN、SDANNI和PNN50差异有统计学意义(P<0.05),高血压并脑梗组SDNN和PNN50亦有显著差异;第2次降压后与第1次降压后比较,仅SDNN有显著差异(P<0.05)。结论高血压及合并腔隙性脑梗死患者心率变异性均有不同程度降低,合理降压治疗可部分提高不同病理阶段高血压患者心率变异性,改善自主神经功能。
Objective To study the effect of different degrees of antihypertension on heart rate variability in elderly patients with hypertension and lacunar infarction, and to explore the differences of HRV in different pathological states of hypertension. Methods Thirty-three elderly patients with essential hypertension (hypertension group) and lacunar infarction (lacunar infarction group) were selected as observation objects. In the same period, 27 healthy volunteers (healthy control group) Changes of heart rate variability parameters at different blood pressure levels before and after treatment. Results The indexes of heart rate variability in patients with hypertension and cerebral infarction before and after treatment with antihypertensive treatment were all significantly lower than those in the normal control group. Hypertension and cerebral infarction were more obvious than those in the hypertensive group. However, Only SDNNI and RMSSD difference was statistically significant (P <0.05). After antihypertensive treatment, no matter in hypertensive group or hypertensive group and cerebral infarction group, the index in each time domain increased to some extent. The second step-down was more obvious than the first step-down in each time domain. After the first depressurization and before depressurization, the differences of SDANNI and PNN50 in hypertensive subjects were statistically significant (P <0.05). After the second depressurization and before depressurization, SDNN , SDANNI and PNN50 were significantly different (P <0.05), but there was also a significant difference between SDNN and PNN50 in hypertensive cerebral infarction group. Only the SDNN was significantly different between the second decompression and the first decompression P <0.05). Conclusions The heart rate variability in patients with hypertension and lacunar infarction is reduced to some extent. The reasonable antihypertensive therapy can partially improve the heart rate variability and improve the autonomic nervous function in patients with different pathological stages of hypertension.