妊娠中晚期婦女血壓變化及焦慮抑郁與心率變異性的關系

徐婭楠 高紅 胡智芳 楊燕

[摘要] 目的 探討妊娠期高血壓合并焦慮抑郁患者與正常妊娠中晚期婦女心率變異性的差異，了解妊娠期高血壓合并焦慮抑郁患者心血管自主神經功能變化。 方法 對2017年9月～2018年4月在首都醫科大學附屬北京婦產醫院進行動態心電圖檢查的中晚期妊娠期婦女進行分組，30名無并發癥的正常妊娠婦女為正常組，30例妊娠期高血壓患者為對照組，根據貝克焦慮量表量表篩查出妊娠期高血壓合并焦慮抑郁患者22例為觀察組，分析其心率變異性相關參數。 結果 對照組和觀察組正常竇性RR間期的總體標準差（SDNN）、每5分鐘竇性RR間期標準差均值（SDNNin）、正常連續竇性RR間期差值均方根（rMSSD）、相鄰RR間期差值>50 ms百分比（PNN50）、三角指數、高頻譜功率（HF）、低頻譜功率（LF）、超低頻功率（VLF）均低于正常組，差異有統計學意義（P < 0.05）;觀察組SDNN、SDNNin、rMSSD、PNN50、三角指數、HF、LF、VLF均低于對照組，差異有統計學意義（P < 0.05）。妊娠期高血壓患者SDNN、HF、LF與24 h平均收縮壓（r = -0.649、-0.795、-0.825）、24 h平均舒張壓（r = -0.504、-0.443、-0.640）及焦慮抑郁評分（r = -0.527、-0.421、-0.625）均呈負相關（P < 0.01）。 結論 心率變異性可作為評估妊娠期高血壓合并焦慮抑郁患者心臟自主神經功能變化的無創性參考指標。

[關鍵詞] 妊娠期高血壓;心率變異性;自主神經功能;焦慮抑郁

[中圖分類號] R714.24+6? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1673-7210（2019）07（c）-0100-04

Correlation of heart rate variability in hypertensive patients with anxiety and depression during pregnancy

XU Ya′nan? ?GAO Hong? ?HU Zhifang? ?YANG Yan

Department of Internal Medicine， Beijing Obstetrics and Gynecology Hospital， Capital Medical University， Beijing? ?100026， China

[Abstract] Objective To investigate the difference of heart rate variability between patients with pregnancy-induced hypertension （PIH） complicated with anxiety and depression and normal women in the middle and late pregnancy， and to understand the changes of cardiovascular autonomic nervous function in patients with pregnancy-induced hypertension complicated with anxiety and depression. Methods From September 2017 to April 2018， the mid-late pregnancy women who underwent dynamic electrocardiogram examination in Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University were divided into three groups. 30 normal pregnant women without complications were the normal group and 30 PIH patients were the control group. 22 PIH patients with anxiety and depression were screened by Beck Anxiety Scale as the observation group， and their heart rate changes were analyzed. Anisotropic correlation parameters. Results Total standard deviation of normal sinus RR interval （SDNN）， the mean standard deviation of sinus RR interval every 5 minutes （SDNNin）， the root mean square of normal continuous sinus RR interval （rMSSD）， the percentage difference of adjacent RR interval > 50 ms （PNN50）， triangular index， high frequency spectral power （HF）， low frequency power （LF） and very low frequency power （VLF） in control group and observation group were lower than those in normal group， and the difference were statistically significant （P < 0.05）. SDNN， SDNNin， rMSSD， PNN50， triangular index， HF， LF and VLF in observation group were lower than those in control group， the differences were statistically significant （P < 0.05）. The mean systolic blood pressure （r = -0.649， -0.795， -0.825）， mean diastolic blood pressure （r = 0.504， -0.443， -0.640） and anxiety and depression scores （r = -0.527， -0.421， -0.625） were negatively correlated with gestational hypertension （P < 0.01）. Conclusion Heart rate variability can be used as a non-invasive reference index for evaluating the changes of cardiac autonomic nervous function in patients with PIH complicated with anxiety and depression.