心率变异性在妊娠期疾病中的应用研究进展

朱美琳 郑文慧 程莉莉 董有静

[摘要] 妊娠期母体特殊的生理及心理变化会导致某些疾病的发生，如妊娠期高血压，妊娠期糖尿病、妊娠期睡眠呼吸暂停综合征等。妊娠期疾病的发生发展与妊娠期母体自主神经功能的变化密切相关，如先兆子痫产妇的极低频功率与低频功率（LF）显著升高；妊娠期糖尿病产妇夜间的高频功率（HF）下降明显；妊娠期睡眠呼吸综合征患者LF/HF升高；先天性心脏病产妇的24 h连续正常RR间期的标准差、HF和LF明显降低；心律失常产妇的心率变异性变化存在争议。心率变异性可通过安全无创手段监测自主神经的变化，对评价及预测妊娠期母体系统病变有重要的临床价值。

[关键词] 心率变异性；频域分析；时域分析；妊娠期高血压疾病；妊娠期糖尿病；妊娠期睡眠呼吸暂停综合征

[中图分类号] R714.2 [文献标识码] A [文章编号] 1673-7210（2018）02（c）-0031-04

Research progress in application of heart rate variability in pregnancy disease

ZHU Meilin ZHENG Wenhui CHENG Lili DONG Youjing

Department of Anesthesiology， Shengjing Hospital of China Medical University， Liaoning Province， Shenyang 110000， China

[Abstract] Particular physical and psychological changes in the maternal body during pregnancy can lead to the occurrence of certain diseases， such as gestational hypertension， gestational diabetes， gestational sleep apnea syndrome， etc. The development of pregnancy disease is closely related to the change of maternal autonomic nervous function during pregnancy， for example， the very low frequency （VLF） and low frequency （LF） of pregnant women with preeclampsia increased significantly. The high frequency （HF） of pregnant women with gestational diabetes decreased significantly at night. The LF/HF of pregnant women with sleep apnea syndrome increased. The 24 hours standard deviation of NN intervals， HF and LF of the patients with congenital heart disease were significantly decreased， and the Heart rate variability （HRV） variation of the mothers with arrhythmia was controversial. HRV connected by safe noninvasive means can monitor the change of autonomic nerve and it has important clinical value in the evaluation and prediction of pregnancy maternal system disease.

[Key words] Heart rate variability； Frequency domain analysis； Time domain analysis； Gestational hypertension； Gestational diabetes； Gestational sleep apnea syndrome

心率變异性（heart rate variability，HRV）是指心电图中的RR间期变异性，反映心率连续波动的瞬时变化。由于其产生于自主神经系统对心脏窦房结的调节作用，故可以作为反映心脏自主神经系统平衡的指标，并为评估交感和副交感神经系统的状况及二者的相互作用提供参考。HRV监测手段安全无创，在反映心脏自主神经系统和外周压力感受器调节的灵敏度方面要高于血压、心率等指标[1-2]。因此，HRV不仅在评价及预测妊娠期母体自主神经功能状态上得到广泛应用，而且在评价相关妊娠期疾病的临床作用方面也日益受到人们的关注。

1 HRV的分析方法