摘要目的 探讨动脉导管未闭(PDA)患儿介入封堵术前后心率变异性及血浆肾上腺髓质素、B型利钠肽(BNP)水平的变化及临床意义.方法 选择55例PDA患儿作为PDA组,在介入封堵术前3 d及术后3 d、3个月分别检测心率变异性频域(总频谱、极低频功率、低频功率、高频功率、低频功率/高频功率)结果及血浆肾上腺髓质素、BNP水平.另选60名健康儿童作为对照组.结果 (1)与对照组比较,PDA组术前心率变异性频域总频谱、极低频功率、高频功率均较低,而低频功率/高频功率及血浆肾上腺髓质素、BNP水平均较高(均P＜0.01).(2)介入封堵术后3 d及3个月,血浆肾上腺髓质素水平均较术前明显降低(均P＜0.01),而与对照组比较差异无统计学意义.心率变异性及血浆BNP水平术后3 d与术前差异无统计学意义.与术前比较,术后3个月心率变异性频域总频谱、极低频功率、高频功率均明显升高(P＜0.01或P＜0.05),而低频功率/高频功率及血浆BNP水平明显降低(均P＜0.01).结论 心率变异性及血浆肾上腺髓质素、BNP水平在PDA介入封堵术后均改善,可作为了解PDA介入封堵术后心脏自主神经及内分泌功能恢复的随访指标.

abstractsObjective To observe the changes of heart rate variability (HRV),adrenomedullin (ADM) and B-type natriuretic peptide(BNP) before and after transcatheter closure in children with patent ductus arteriosus.Methods HRV spectral values (TF,VLF,LF,HF,LF/HF) were detected by 24 dynamic electrocardiogram and the concentrations of plasma ADM and BNP were measured in 55 children with patent ductus arteriosus(Group PDA,n =55) before and 3~(rd) day,3~(rd) month after transcatheter closure therapy,and in 60 normal children (Group C).Results (1) Compared with Group C,the HRV spectral values (TF,VLF,HF)were significantly lower (all P＜0.01),LF/HF and the concentrations of plasma ADM,BNP were significantly higher in patients with PDA before transcatheter closure (all P＜0.01).(2) Compared with the values before transcatheter closure values,plasma ADM were significantly reduced at 3~(rd) day and 3~(rd) month after transcatheter closure(P＜0.01),the HRV spectral values (TF,VLF,HF) were significantly increased while LF/HF and plasma BNP were significantly decreased at 3~(rd) month after transcatheter closure (P＜0.01 or P＜0.05).Conclusions HRV and plasma ADM,BNP improved significantly post tnmscatheter closure in children with patent ductus arteriosus.