以动态心电图心室率参数指导心房颤动伴长R-R间距者活动时心室率的控制

Dynamic electrocardiogram in atrial fibrillation with long R-R and ventricular rate control during activity situation

目的探讨心房颤动(Af)伴长R-R间距活动时的心室率控制情况。方法回顾分析92例住院者的动态心电图(DCG)检查结果,其中:①Af伴长R-R间距62例(A组);②窦性心律、偶发房性早搏及室性早搏30例(B组)。观察两组的心室率分布情况。将A组患者在强心、利尿、抗凝的药物治疗基础上随机分为:常规组(A1组)30例,倍他乐克25毫克2/日;非常规组(A2组)32例,倍他乐克50毫克1/日。采用最高、最低、平均心室率、24h总心室率、每小时平均心率等参数,分析Af伴长R-R间距的心室率控制情况。结果 A组最高心率、平均心率、24h总心率均快于B组,差别有统计学意义(P<0.05,P<0.001)。A组最低心率慢于B组最低心率,差别有统计学意义(P<0.001)。通过适当增加晨起给药量倍他乐克50毫克1/日能达到更好的运动时心室率的控制。患者的最高心率、平均心率、24h总心率均慢于A1组,差别有统计学意义(P<0.05,P<0.001)。其最低心率与B组差别无统计学意义(P>0.05)。结论采用24h DCG对心室率等各项参数进行观察,为临床治疗和疗效的判断提供依据。提示在心室率高峰前用药,即合理增加晨起给药量,可达到改善目前Af伴长R-R间距活动时的心室率控制不佳而夜间长R-R间距出现增多的问题。

Objective To investigate atrial fibrillation with long R-R and ventricular rate control during activity situation. Methods 92 patients dynamic electrocardiogram(DCG) were analyzed.Among them,atrial fibrillation with long R-R interval,62 cases(Group A),sinus rhythm,30 cases(Group B).Group A was divided into conventional group(30 cases,Group A1): Betaloc 25 mg,2 times/day,and unconventional group(32 cases,Grpup A2): Betaloc 50 mg,1 time/day.Fibrillation with long RR and ventricular rate control with the highest,lowest,average ventricular rate,24h total ventricular rate,average ventricular rate per hour. Results Group A had faster highest heart rate,average heart rate,24-hour total heart rate than Group B(P 0.05). Conclusion Dynamic electrocardiogram is an important way to evaluate atrial fibrillation with long R-R and ventricular rate control..