摘要目的：探讨改善睡眠对成人慢性心力衰竭患者心率变异性( HRV )和心功能的影响。方法选取2012年1月—2013年1月河北省张家口市第一医院收治的成人慢性心力衰竭伴失眠患者38例作为对照组,选取2013年2月—2014年1月收治的成人慢性心力衰竭伴失眠患者38例作为观察组。两组患者均接受慢性心力衰竭的常规药物治疗,对照组采取常规护理方法,观察组在常规护理基础上给予改善患者睡眠质量护理。比较两组患者护理前后窦性RR间期标准差( SDNN)、每5分钟窦性RR间期均值的标准差( SDANN)、所有邻近窦性RR间期长度之差的均方根值( rMSSD)、50 ms间隔以上邻近周期的比例(pNN50)、高频(HF)和低频(LF)等心率变异性和左心室射血分数(LVEF)等心功能变化,及患者对治疗和护理效果的满意度。结果护理4周后,观察组患者失眠率为28.95%,对照组为55.26%,差异有统计学意义(χ2=5.398,P<0.05)。护理2,4周后,观察组与对照组比较,其心率变异性和LVEF均升高,差异有统计学意义(P<0.05)。 Pearson相关性分析结果显示,患者SDNN、SDANN和pNN50与其LVEF均呈正相关(r值分别为0.759,0.788,0.772；P<0.05)。患者出院时,观察组患者对治疗和护理效果非常满意的患者比例、患者整体满意度均高于对照组,但两组比较差异无统计学意义(χ2=3.742,P>0.05)。结论采用改善慢性心力衰竭患者睡眠的护理可有效提高其心率变异性指标和LVEF,因此改善睡眠有利于成人慢性心力衰竭患者的心功能的改善。

abstractsObjective To explore the influences of improving sleep on heart rate variability ( HRV) and cardiac function of adult chronic heart failure patients. Methods We selected 38 adult chronic heart failure ( CHF) patients with insomnia from January 2012 to January 2013 from the Number One Hospital of Zhangjiakou as control group, and 38 patients from February 2013 to January 2014 as observation group. Patients of two&nbsp;groups were treated with conventional medicine treatment about CHF and routine care, and the patients of observation group received nursing care to improve patients′ sleep quality based on routine care. Standard deviation of NN intervals (SDNN), SDANN, rMSSD, pNN50, the high frequency (HF) and low frequency ( LF) and other HRV indexes, LVEF and patients′ satisfaction with effectiveness of medical treatment and nursing between two groups were analyzed. Results After 4 weeks nursing, the rate of patients with insomnia in the observation group was 28. 95% and 55. 26% in the control group (χ2 =5. 398, P<0. 05). After 2 and 4 weeks nursing, HRV and LVEF were all improved between control and observation groups (P<0. 05). Pearson correlation analysis showed that patients′SDNN, SDANN and pNN50 were positively correlated with LVEF ( r=0. 759, 0. 788, 0. 772;P<0. 05). The observation group were higher than the control group in proportion of patients′satisfaction for the effects of medical treatment and nursing and the patients′ overall satisfaction when patients discharged from hospital (χ2 =3. 742,P>0. 05). Conclusions Improving CHF patients′sleep quality can improve HRV and LVEF effectively. Improving sleep is in favor of improving heart function because the HRV is related to heart function.