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目的探讨急性出血性脑血管病患者心率减速力(DC)的变化及可能的应用价值。方法选取急性脑出血、原发性蛛网膜下腔出血(SAH)患者128例,其中SAH组48例,右基底节区出血组30例,左基底节区出血组28例,非基底节区出血组22例,于入院当日行24 h动态心电图监测。选取体检正常者80例作对照。计算机自动计算各组DC值及心率变异(HRV)值。入选卒中患者按照DC≤2.5 ms、DC 2.6~4.5 ms、DC>4.5 ms分组,统计各组24 h平均心率、心律失常事件、ST-T改变、肌钙蛋白(cT nT)增高、左室射血分数(EF)以及临床转归等临床指标。统计不同卒中部位DC≤4.5 ms及DC>4.5 ms的发生率。对入选患者随访6个月,计算病死率。结果与正常组比较,各卒中组DC及HRV值显著性降低(P<0.01),不同卒中组间比较无显著性差异。与DC>4.5 ms组比较,DC≤2.5 ms组的24 h平均心率、心律失常事件、cT nT增高、病死率有显著性差异(P<0.01);各卒中组间DC≤4.5ms及DC>4.5ms的发生率无显著性差异。结论 DC≤2.5 ms有望成为出血性脑血管病患者急性期发生恶性心律失常及猝死的预警指标。
Objective To investigate the changes of heart rate deceleration (DC) in patients with acute hemorrhagic cerebrovascular disease and its possible value. Methods A total of 128 patients with acute cerebral hemorrhage and primary subarachnoid hemorrhage (SAH) were enrolled. Among them, 48 were in SAH group, 30 were in right basal ganglia hemorrhage group, 28 were in left basal ganglia hemorrhage group and non-basal ganglia hemorrhage Group of 22 cases, on the day of admission line 24 h Holter monitoring. 80 normal subjects were selected as control. The computer automatically calculates the DC and heart rate variability (HRV) values for each group. The stroke patients were divided into two groups according to DC≤2.5 ms, DC 2.6 ~ 4.5 ms and DC> 4.5 ms. The average heart rate, arrhythmia, ST-T changes, cTnT, Blood test (EF) and clinical outcome and other clinical indicators. Statistics of different stroke sites DC ≤ 4.5 ms and DC> 4.5 ms incidence. The selected patients were followed up for 6 months to calculate the case fatality rate. Results Compared with the normal group, the DC and HRV of each stroke group decreased significantly (P <0.01). There was no significant difference between the different stroke groups. Compared with DC> 4.5 ms group, 24 h average heart rate, arrhythmia events and cT nT were significantly increased in DC≤2.5 ms group (P <0.01); DC≤4.5 ms and DC> The incidence of 4.5ms no significant difference. Conclusion DC ≤ 2.5 ms is expected to be an early warning indicator of malignant arrhythmia and sudden death in patients with hemorrhagic cerebrovascular disease.