妊娠中晚期妇女血压变化及焦虑抑郁与心率变异性的关系

徐娅楠 高红 胡智芳 杨燕

[摘要] 目的 探討妊娠期高血压合并焦虑抑郁患者与正常妊娠中晚期妇女心率变异性的差异，了解妊娠期高血压合并焦虑抑郁患者心血管自主神经功能变化。 方法 对2017年9月～2018年4月在首都医科大学附属北京妇产医院进行动态心电图检查的中晚期妊娠期妇女进行分组，30名无并发症的正常妊娠妇女为正常组，30例妊娠期高血压患者为对照组，根据贝克焦虑量表量表筛查出妊娠期高血压合并焦虑抑郁患者22例为观察组，分析其心率变异性相关参数。 结果 对照组和观察组正常窦性RR间期的总体标准差（SDNN）、每5分钟窦性RR间期标准差均值（SDNNin）、正常连续窦性RR间期差值均方根（rMSSD）、相邻RR间期差值>50 ms百分比（PNN50）、三角指数、高频谱功率（HF）、低频谱功率（LF）、超低频功率（VLF）均低于正常组，差异有统计学意义（P < 0.05）;观察组SDNN、SDNNin、rMSSD、PNN50、三角指数、HF、LF、VLF均低于对照组，差异有统计学意义（P < 0.05）。妊娠期高血压患者SDNN、HF、LF与24 h平均收缩压（r = -0.649、-0.795、-0.825）、24 h平均舒张压（r = -0.504、-0.443、-0.640）及焦虑抑郁评分（r = -0.527、-0.421、-0.625）均呈负相关（P < 0.01）。 结论 心率变异性可作为评估妊娠期高血压合并焦虑抑郁患者心脏自主神经功能变化的无创性参考指标。

[关键词] 妊娠期高血压;心率变异性;自主神经功能;焦虑抑郁

[中图分类号] R714.24+6          [文献标识码] A          [文章编号] 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.