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Objective To investigate the relationship of National Institute of Health Stroke Scale(NIHSS)with heart rate variability(HRV)and cardiac complication in elderly patients with acute cerebral infarction,and to clarify the effect of early drug intervention on the regulation of autonomic nerve function in patients with high NIHSS score.Methods One hundred twenty-six inpatients with first-onset acute cerebral infarction(ACI)(the cerebral infarction group)and 40 healthy subjects with no history of stroke (the control group)were retrospectively enrolled.All subjects underwent examinations of NIHSS and 24 h dynamic electrocardiogram.According to NIHSS score,patients in the cerebral infarction group were divided into 3 subgroups:NIHSS score 0-4 group(n=32),NIHSS score 5-15 group(n=66)and NIHSS score ≥ 15 group(n=28).The difference in HRV parameters were compared between ACI patients and the controls.Ninety-four ACI patients with NIHSS score ≥5 were randomly divided into 2 groups:(1)the traditional treatment group(n=44),taking routine drugs for cerebral infarction;(2) the special treatment group (n =42),taking metoprolol sustained release tablet and Shensonyangxin capsule as add-on to the routine drugs for cerebral infarction.The 24 h dynamic electrocardiogram examination were conducted 30 days after treatment.The differences in HRV parameters and cardiac complications were compared between the two treatment groups.Results In patients with acute cerebral infarction,the time-domain parameters of normal-to-normal intervals (NNI),standard deviation of normal-to-normal intervals(SDNN),square root of the mean squared successive differences between normal-to-normal RR intervals (RMSSD),percentage of adjacent normal-to-normal intervals that differed more than 50 ms(PNN50),frequency domain parameters low-frequency(LF)power and high-frequency(HF)power were significantly reduced as compared with those in the control group(P＜0.05).While,pulse rate and frequency domain parameters of sympathetic vagus balance index (LF/HF)were significantly increased (P ＜ 0.05).The time-domain parameters (NNI,SDNN,RMSSD and PNN50) and frequency domain parameters(LF,HF)were significantly reduced in the NIHSS score 5-15 group and NIHSS score ≥15 group as compared with the control group and the NIHSS score 0-4 group(P＜0.05).The time-domain parameters(RMSSD and PNN50)and frequency domain parameters(LF and HF)were reduced(P＜0.05),and the frequency domain parameters(LF/HF) were increased(P＜0.05)in NIHSS score ≥ 15 group compared with in NIHSS score 5-15 group(P＜0.05).Compared with pro-treatment,the special treatment group after treatment showed that the time domain parameters(NNI,SDNN,RMSSD and PNN50)and frequency domain parameters(LF and HF) were significantly increased (P ＜ 0.05),the frequency domain parameters(LF/HF) were significantly reduced (P ＜ 0.05) and the incidence of cardiac complication (total incidence of atrial arrhythmias and ventricular arrhythmias and cardiac complication)were significantly reduced(P＜0.05).As compared with the traditional treatment group after treatment,the special treatment group after treatment showed that the time domain parameters(NNI,SDNN,RMSSD and PNN50)and frequency domain parameters (LF and HF) were significantly increased (P ＜ 0.05),frequency domain parameters(LF/HF) were significantly reduced (P ＜ 0.05) and the total incidence of cardiac complication were significantly reduced(18.4％ or 7 cases vs.40.0％ or 16 cases,P＜0.05).Conclusions The HRV is decreased in patients with acute cerebral infarction.The reduction degree of HRV is more significant along with the higher NIHSS scores,which suggests that patients with high NIHSS scores are prone to an impairment of autonomic nerve function.For patients with high NIHSS scores after stroke,early drug intervention for regulating autonomic nerve function can effectively prevent the occurrence of cardiac emergencies and improve the prognosis of stroke.
ABSTRACT
Objective@#To investigate the relationship of National Institute of Health Stroke Scale(NIHSS)with heart rate variability(HRV)and cardiac complication in elderly patients with acute cerebral infarction, and to clarify the effect of early drug intervention on the regulation of autonomic nerve function in patients with high NIHSS score.@*Methods@#One hundred twenty-six inpatients with first-onset acute cerebral infarction(ACI)(the cerebral infarction group)and 40 healthy subjects with no history of stroke(the control group)were retrospectively enrolled.All subjects underwent examinations of NIHSS and 24 h dynamic electrocardiogram.According to NIHSS score, patients in the cerebral infarction group were divided into 3 subgroups: NIHSS score 0-4 group(n=32), NIHSS score 5-15 group(n=66)and NIHSS score ≥ 15 group(n=28). The difference in HRV parameters were compared between ACI patients and the controls.Ninety-four ACI patients with NIHSS score ≥5 were randomly divided into 2 groups: (1)the traditional treatment group(n=44), taking routine drugs for cerebral infarction; (2)the special treatment group(n=42), taking metoprolol sustained release tablet and Shensonyangxin capsule as add-on to the routine drugs for cerebral infarction.The 24 h dynamic electrocardiogram examination were conducted 30 days after treatment.The differences in HRV parameters and cardiac complications were compared between the two treatment groups.@*Results@#In patients with acute cerebral infarction, the time-domain parameters of normal-to-normal intervals(NNI), standard deviation of normal-to-normal intervals(SDNN), square root of the mean squared successive differences between normal-to-normaI RR intervals(RMSSD), percentage of adjacent normal-to-normal intervals that differed more than 50 ms(PNN50), frequency domain parameters low-frequency(LF)power and high-frequency(HF)power were significantly reduced as compared with those in the control group(P<0.05). While, pulse rate and frequency domain parameters of sympathetic vagus balance index(LF/HF)were significantly increased(P<0.05). The time-domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF, HF)were significantly reduced in the NIHSS score 5-15 group and NIHSS score ≥15 group as compared with the control group and the NIHSS score 0-4 group(P<0.05). The time-domain parameters(RMSSD and PNN50)and frequency domain parameters(LF and HF)were reduced(P<0.05), and the frequency domain parameters(LF/HF)were increased(P<0.05)in NIHSS score ≥15 group compared with in NIHSS score 5-15 group(P<0.05). Compared with pre-treatment, the special treatment group after treatment showed that the time domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF and HF)were significantly increased(P<0.05), the frequency domain parameters(LF/HF)were significantly reduced(P<0.05)and the incidence of cardiac complication(total incidence of atrial arrhythmias and ventricular arrhythmias and cardiac complication)were significantly reduced(P<0.05). As compared with the traditional treatment group after treatment, the special treatment group after treatment showed that the time domain parameters(NNI, SDNN, RMSSD and PNN50)and frequency domain parameters(LF and HF)were significantly increased(P<0.05), frequency domain parameters(LF/HF)were significantly reduced(P<0.05)and the total incidence of cardiac complication were significantly reduced(18.4% or 7 cases vs.40.0% or 16 cases, P<0.05).@*Conclusions@#The HRV is decreased in patients with acute cerebral infarction.The reduction degree of HRV is more significant along with the higher NIHSS scores, which suggests that patients with high NIHSS scores are prone to an impairment of autonomic nerve function.For patients with high NIHSS scores after stroke, early drug intervention for regulating autonomic nerve function can effectively prevent the occurrence of cardiac emergencies and improve the prognosis of stroke.
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Objective To investigate the Lemple-Zie complexity (LZC) characteristics in patients with Alzheimer' s disease(AD),mild cognitive impairment(MCI) and normal elderly,and the possibility of differentiating AD,MCI and normal elderly by LZC.Methods Electroencephalogram (EEG) of 30 AD patients,30 MCI patients and 20 normal elderly with eyes closed in rest state were recorded.In acquired EEG data,2048 points(10.14 s)of each channel were selected for LZC calculation by Matlab 7.0 software.Results (1) The average LZC values in AD,MCI and control groups were 0.396 ± 0.036,0.470 ±0.051,0.523 ±0.055 respectively.As compared with control group,the values in AD and MCI groups were decreased (F =43.092,P =0.000).(2) LZC values of AD in all channels (from 0.373 ± 0.042 to 0.430 ±0.083),whole brain,bilateral hemispheres,frontal and temporal areas were significantly lower than those in the normal group (from 0.498 ± 0.067 to 0.566 ± 0.059 ; t =3.602-8.747,P =0.000-0.010),and showed the significant decline(＞ 23％)in bilateral anterior middle temporal,frontal areas,the left parietal area.(3) Except the T6 channel,LZC values of AD groups in the remaining channels(from 0.373 ±0.042 to 0.418±0.063),the whole brain,bilateral hemispheres,frontal and temporal areas were significantly lower than those in the MCI group(from 0.455 ± 0.072 to 0.489 ± 0.063 ; in T5 channel,t =2.038,P =0.041,the others t=4.178-7.424,all P=0.000).(4) LZC values of MCI groups in the whole brain,bilateral hemispheres,temporal areas,parietal areas,the left frontal area were notably lower than those in the control group.Conclusions With the decline of the cognitive function,the EEG complexity value shows the parallel change.It suggests that the EEG complexity value can reflect the change of brain function in the duration from normal age to dementia in some degree; The MCI patients with abnormal LZC values in temporal and frontal lobes have a certain degree relation with the occurrence of AD.