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目的探讨老年慢性心力衰竭(CHF)患者QRS时限(QRSD)与心率震荡(HRT)及心功能的相关性。方法46例老年慢性心衰患者(心衰组),20例健康对照组。在心衰组根据NYHA分为轻度心衰组(NYHAⅠ～Ⅱ级,n=20),重度心衰组(NYHAⅢ～Ⅳ级,n=26)。以左心室射血分数(LVEF)、左室舒张末期内径(LVDED)作为心脏功能指标,常规心电图测量QRSD,与心率震荡参数震荡初始(TO)和震荡斜率(TS)进行组间比较。结果心衰组QRSD、LVDED、TO值明显高于对照组,LVEF、TS值明显低于对照组。在心衰组QRSD与LVDED、TO呈正相关,与LVEF、TS呈负相关。结论在慢性心衰患者中监测QRS时限和心率震荡,及时筛选出高危猝死患者,动态评估心衰进展程度,指导临床采取相应的干预模式。
Objective To investigate the correlation between QRS duration (QRSD), heart rate turbulence (HRT) and cardiac function in elderly patients with chronic heart failure (CHF). Methods 46 cases of elderly patients with chronic heart failure (heart failure group), 20 healthy controls. The patients with heart failure were divided into mild heart failure group (NYHA Ⅰ ~ Ⅱ grade, n = 20) and severe heart failure group (NYHA Ⅲ ~ Ⅳ grade, n = 26) according to NYHA. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDED) were taken as the indexes of cardiac function, QRSD was measured by conventional electrocardiogram, and the initial oscillatory parameters (TO) and concussion slope (TS) were compared between groups. Results Heart failure group QRSD, LVDED, TO value was significantly higher than the control group, LVEF, TS value was significantly lower than the control group. In heart failure group, QRSD was positively correlated with LVDED and TO, but negatively correlated with LVEF and TS. Conclusions QRS duration and heart rate turbulence are monitored in patients with chronic heart failure, and the patients with sudden death at high risk are screened out in time to assess the progression of heart failure dynamically to guide the clinical intervention mode.