以心律變異分析來評估急性缺血性腦中風的自律神經功能變化

Analysis of Heart Rate Variability to Assess the Changes in Sympathovagal Balance after Acute Ischemic Stroke

陳建甫(Chien- Fu Chen)

指導教授 ： 賴秋蓮

高雄醫學大學/醫學院/神經學科研究所/碩士(2009年)

https://doi.org/10.6832/KMU.2009.00092

摘要

心血管自律神經功能障礙是急性腦梗塞後一個常見的併發症，心律變異的頻
譜分析已被用來當評估自律神經的一項功能性指標。本研究目的是利用頻譜分析探討腦梗塞及其不同受損部位在急性期對心血管自律神經功能所造成的影響。
研究對象包括75位急性腦梗塞患者，其中包括46位男性29位女性，平均
年齡59.61±11.71歲；28位是右大腦半球梗塞，29位左大腦半球梗塞，18位是腦幹梗塞。對照組81位，其中包括37位男性44位女性，平均年齡 56.83±8.35歲。均接受心律變異分析評估、相關心血管功能指標包括躺臥與直立姿勢的血壓心跳測量與心血管自律神經功能症狀問卷。
在低頻、高頻、高頻指標百分比值的比較，中風組較對照組之測量為低；而
在低頻指標百分比值, 低頻和高頻指標之比值的比較，則中風組較對照組之測量值為高。意味著急性腦梗塞會使心律變異性降低而造成交感神經功能亢進與減低迷走神經活性。ANOVA顯著後組間之兩兩比較顯示在低頻、高頻、高頻指標之比值與低頻和高頻指標之比值比較上，腦幹中風組病人相較對照組有顯著的差異性；而在低頻指標百分比值、高頻指標之比值及低頻和高頻指標之比值比較上，左大腦半球中風組病人相較對照組有顯著的差異性。
我們發現急性腦梗塞會導致心血管自律神經功能失調。與兩側腦半球相比較，腦幹梗塞在心律變異分析上造成較嚴重的副交感功能的減弱與交感功能的增強的影響。而左腦半球較右腦半球梗塞易造成交感與迷走神經調控作用的影響。

關鍵字

心血管自律神經功能 ； 急性腦梗塞 ； 心律變異

並列摘要

Cardiac autonomic dysfunction is a common complication after acute ischemic
stroke (IS). Frequency-domain analysis of heart rate variability (HRV) has gained its popularity with broad applications as a functional indicator of autonomic nervous system. The aim of this study was to investigate the changes in sympathovagal balance and a possible localization dependent difference after acute IS.
We studied 75 consecutive acute IS patients with measurements of HRV and associated cardiac autonomic parameters compared to 81 control subjects. Of the 75 patients, 28 had right-sided hemispheric (RH) infarction, 29 had left-sided hemi -spheric (LH) infarction, and 18 had brainstem (BS) infarction. 81 age-matched normal controls (37 men and 44 women; mean age 56.83±8.35 years) were recruited from the hospital and general community. Measurements of HRV and associated parameters including supine and head-up tilt blood pressure and heart rate and the questionares of cardiovascular symptoms were performed in all subjects.
Low frequency (LF), high frequency (HF) and HF% in stroke patients were lower than those of the control subjects. The value of LF%, LF/HF were significantly higher
than those of the controls. The results revealed that acute IS cause the decrease of HRV and exaggerated sympathetic activation and reduced vagal activity. Comparison of HRV in different localization of stroke patients with controls showed significant differences in LF, HF, LF%, HF%, and LF/HF among stroke groups. Post-hoc comparison identified significant differences between BS versus controls in LF, HF, HF%, LF/HF and between LH versus controls in LF%, HF% and LF/HF.
Acute IS causes damage to the cardiac autonomic system manifested on the HRV. Acute BS correlated with greatest reduced parasympathetic and increased sympathetic inpact. In addition, LH had more sympathovagal modulation compared to RH.

並列關鍵字

Cardiac autonomic function ； acute cerebral infarction ； heart rate variability

參考文獻

參考文獻

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