心率变异性与急性缺血性卒中患者静脉溶栓后早期神经功能恶化的相关性分析
Correlation between heart rate variability and early neurological deterioration after intravenous thrombolysis in patients with acute ischemic stroke
吴小燕 1陈婷 2邱友燕 3倪晓俊 1钟健强 1郭建军1
作者信息
- 1. 广州医科大学附属第四医院神经内科,广州 511300
- 2. 广州市食品检验所,广州 510520
- 3. 广州医科大学附属第四医院内分泌科,广州 511300
- 折叠
摘要
目的 探讨心率变异性(HRV)与急性缺血性卒中患者重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓后早期神经功能恶化(END)的关系.方法 回顾性分析2019年7月至2023年08月广州医科大学附属第四医院神经内科诊治的222例急性缺血性卒中患者,根据入院72h是否发生END将其分为END组(58例)和非END组(164例).对比两组患者rt-PA静脉溶栓后心率变异性[HRV;包括时域参数R-R间期的标准差(SDNN)、R-R间期差值的均方根(RMSSD)和频域参数低频(LF)、高频(HF)、低频与高频成分比值(LF/HF)]的差异,并对影响溶栓后发生END的因素进行多因素二元Logistic回归分析.结果 与非END组对比,END组患者SDNN[79.50(63.75,92.50)ms 比 103.00(78.00,119.75)ms,P＜0.001]、RMSSD[22.00(15.00,29.00)ms 比25.50(20.00,35.00)ms,P=0.016]、LF[157.70(65.23,368.65)ms2 比 266.00(148.18,476.48)ms2,P=0.007]、HF[86.60(33.85,196.95)ms2 比 140.25(69.03,245.30)ms2,P=0.001]指标均较低且差异均有统计学意义,而年龄[(68.86±10.70)岁比(64.10±10.96)岁,P=0.005]和溶栓前NIHSS评分[7.00(4.00,11.25)比5.00(3.00,9.75),P=0.040]均较高且差异均有统计学意义.多因素二元Logistic回归分析结果表明,SDNN降低是患者静脉溶栓后发生END的危险因素(OR=0.982,95％CI:0.968～0.996).结论 心率变异性降低的急性缺血性卒中患者静脉溶栓后发生END的风险较高.
Abstract
Objective To investigate the relationship between heart rate variability(HRV)and early neurological deterioration(END)in patients with acute ischemic stroke after intravenous thrombolysis with recombinant tissue-type plasminogen activator(rt-PA).Methods A retrospective analysis was conducted on 222 patients with acute ischemic stroke admitted to the Department of Neurology,the Fourth Affiliated Hospital of Guangzhou Medical University from July 2019 to August 2023.According to whether END occurred within 72 hours after admission,the patients were divided into an END group(58 cases)and a non-END group(164 cases).The differences in HRV parameters[including time-domain parameters such as the standard deviation of R-R intervals(SDNN),the square root of the mean squared differences of R-R intervals(RMSSD),and frequency domain parameters such as low frequency(LF),high frequency(HF),and the ratio of LF to HF]were compared between the two groups after intravenous thrombolysis with rt-PA.Multivariate binary Logistic regression analysis was performed to identify factors associated with END after thrombolysis.Results Compared with the non-END group,the END group had lower SDNN[79.50(63.75,92.50)ms vs 103.00(78.00,119.75)ms,P＜0.001],RMSSD[22.00(15.00,29.00)ms vs 25.50(20.00,35.00)ms,P=0.016],LF[157.70(65.23,368.65)ms2 vs 266.00(148.18,476.48)ms2,P=0.007],and HF[86.60(33.85,196.95)ms2 vs 140.25(69.03,245.30)ms2,P=0.001],and these differences were statistically significant.Age[(68.86±10.70)years vs.(64.10±10.96)years,P=0.005]and NIHSS scores before thrombolysis[7.00(4.00,11.25)vs 5.00(3.00,9.75),P=0.040]were higher in the END group,and these differences were also statistically significant.Multivariate binary Logistic regression analysis showed that decreased SDNN was a risk factor for END after intravenous thrombolysis(0R=0.982,95％CI:0.968-0.996).Conclusion Patients with acute ischemic stroke who have reduced heart rate variability are at higher risk of developing END after intravenous thrombolysis.
关键词
心率变异性/急性缺血性卒中/静脉溶栓/早期神经功能恶化Key words
Heart rate variability/Acute ischemic stroke/Intravenous thrombolysis/Early neurologic deterioration引用本文复制引用
基金项目
广州市基础研究计划基础与应用研究项目(202102080592)
广州市增城区科技计划项目(2021-046)
出版年
2023
NETL
NSTL
万方数据