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1
題名:THE ACUTE-PHASE HEART RATE VARIABILITY IN ACUTE CORONARY SYNDROME- THE IMPLICATIONS OF DIFFERENT ANALYSES     (24點)
急性冠心症急性期的心率變異性研究-不同分析方法的不同意涵
著者:Ho-Tsung Hsin(辛和宗) ;Chi-Yu Yang(楊基譽) ;Jiann-Shing Shieh(謝建興) ;Pi-Chi Lin(林丕基) ;Liang-Yu Chen(陳亮宇)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:Acute coronary syndrome ; Detrended fluctuation ; Fractal ; Heart-rate variability ; Power spectrum
刊名:Taiwan Critical Care Medicine
卷期:11卷4期(2010)
頁碼:239-250
語言:英語
摘要: 中文摘要PDF ; 英文摘要PDF

目的:心率變異性(HRV)並非是一成不變的。HRV傳統上是運用power spectrum中的高低頻譜比率來分析,其結果複雜不易瞭解。而新的detrended fluctuation analysis(DFA)則將HRV簡化成一簡單明瞭的指數alpha。再者,之前HRV的研究多半集中於心肌投塞恢復期,或慢性心衰竭病忌,其結果顯示alpha值下降和死夭相關。然而,急性期的HRV在過去並未被仔細探索,因此我們以急性冠心症(ACS)病患和非ACS受試者做對照,來研究急性期HRV的臨床意義。 方法:此研究包含兩部分:一?非ACS受試者的急性壓力模擬,其貳?ACS患者的前瞻性觀察研究。我們擷取非ACS受試者在不同指定強度下運動的各一小時心電圈,以及ACS病患急性期內一小時的心電圖,皆予以DFA和 power spectrum分析,其結果以單變項去做統計。 結果:共有30位非ACS受試者,他們的DFA alpha值隨著運動強度上升而增加(0.95±0.050 to 1.07±0.084 to 1.20±0.083, p<0.05),而ACS病患的alpha值則跟心肌梗塞病程是否有併發症相關(無併發症者1.004±0.0080 vs.有併發症者1.216±0.058,p<0 .05)。而alpha值的變化則不因年齡、ACS分類或其他臨床變項而異。至於power spectrum 的高低頻譜比率只因病灶血管而有差異(RCA/LCx4.23+2.34/4.987 vs. LAD1.87±1.06,p<0.05)。 結論:根據本研究DFA可以用來研究ACS急性期的HRV,而傳統的頻譜分析卻力有未逮。本篇粗淺的指出DFA alpha值的上升,隱含著受試者仍有尚未解決的心因性壓力需要克服。
Purpose: Heart-rate variability (HRV) is non-stationary. HRV is traditionally analyzed by power spectrum (low/high frequency (LF/HF) ratio). Oetrended fluctuation analysis (OFA) deduces HRV to a simple fractal scaling exponent alpha. Previously, HRV studies focused on post-M I and chronic heart failure. The decreased DFA alpha is associated with mortality. The acute-phase HRV has not been elucidated. We intended to evaluate acute-phase HRV of acute coronary syndromes (ACS), in comparison with non-ACS subjects. Methods: Our study had two parts: simulation of acute stress on non-ACS volunteers and the prospective observation in patients of AC S. We assessed 1-hour ECG of volunteers taking three designated intensity of exercise and patients in the acute stage of ACS. All ECG data were analyzed by OFA and power spectrum. The result s of HRV were evaluated by univariate analysis. Results: The 30 volunteers got elevated OFA alpha while the intensity of exercise increased( 0.95±0.050 to 1.07±0.084 to 1.20±0.083, p<0.05). The fractal properties of 33 ACS patients correlated with the complexity of post-M I course(1.004±0.0080 in non-complicated vs. 1.216±0.058 in complicated p<0.05). There was no significance when the fractal scaling exponent was categorized by age , type of ACS and other variables. The LF/HF ratio did not differ in any clinical perspective but between RCA/LCx and LAD groups (4.23 ± 2.34/4.987 vs. 1.87±1.06, p<0.05). Conclusions: DFA can be used to study the acute-phase HRV in ACS, while the traditional power spectral analysis failed. The increased a value derived from OFA may imply unresolved cardiac stress which demands further attention.


    

本卷期目次
Taiwan Critical Care Medicine 11卷4期 (2010)
改善急性腦中風病人血栓溶解治療評估效率之經驗及探討/ 顏正昌盧玉強萬樹人林清煌張運德羅崇誠陳立偉高志翔
THE ACUTE-PHASE HEART RATE VARIABILITY IN ACUTE CORONARY SYNDROME- THE IMPLICATIONS OF DIFFERENT ANALYSES/ Ho-Tsung HsinChi-Yu YangJiann-Shing ShiehPi-Chi LinLiang-Yu Chen
腦死病人生命末期照護/ 張麟黃勝堅蕭勝煌
CARDIOVASCULAR COLLAPSE AFTER GENERAL ANESTHETIC INDUCTION COMBINED WITH ESMOLOL/ Yu-Ling YehYi ChangWen-Wei LiaoHsiang -Chien TsengKuo-Ching Wang
PULMONARY ALVEOLAR PROTEINOSIS TREATED WITH WHOLE LUNG LAVAGE IN INTENSIVE CARE UNIT/ Yao-Chang WangJau-Yeong LuWein-Shung KuoMing-Teng ChungPen-Fang Yeh
NOSOCOMIAL URINARY TRACT INFECTION RELATED RETROPERITONEAL ABSCESS WITH INTERNAL COLONIC FISTULA/ Shih-Hung TsaiWei-Chou ChangChin-Wang HsuShi-Jye ChuWann-Cherng Perng
LIDOCAINE-ASSOCIATED SEVERE DYSPNEAAND PULMONARY INFILTRATES AFTER BRONCHOSCOPY: A CASE REPORT/ Kuan-Chun LinChi-Wen LaChia-An Chou
 
   
 
   

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