充血性心力衰竭合并室性心律失常影响因素的研究

Congestive heart failure with arrhythmias: prevalence and risk factors

采用24小时动态心电图监测技术同步观测64例充血性心力衰竭病人血浆去甲肾上腺素、肾上腺素浓度、血浆肾素活性、血管紧张素Ⅱ浓度、血清电解质和地高辛浓度以及室壁运动等指标与室性心律失常的关系。结果显示:心律失常总发生率为87.5％。室上性心律失常发生率为56.2％;定性心律失常发生率为68.8％,其中高级别(Lown氏分级3级以上)为40.6％。资料分析表明:①虽然大多数病人交感神经系统和肾素血管紧张素系统有激活,但与室性心律失常发生无明显相关;②室壁运动异常和血清钾浓度是影响室性心律失常发生的主要因素,而且前者是独立的危险因素。

The arrhythmic events of 64 patients with congestive heart failure were detected with 24-hour dynamic electrocardiography monitoring technique. Plasma levels of norepinephrin, epinephrin. renin activity, angiotensin-Ⅱ. electrolytes and digoxin were measured simultaneously and the changes of cardiac chambers and ventricular wall movement were observed.Analysis of data showed: 87. 5% of patients complicated with arrhythmias. 56. 2% with supraventricular arrhythmias, 68. 8% with ventricular arrhythmias (VA). Of the latter. 28% with low-grade VA and 40. 6% with high-grade VA i and 22% Of patients experienced with non-sustained ventricular tachycardia.Multivariat analysis of data and univariat analysis of some factors indicated: the sympathetic system and renin-angiotensin system were activated in most patients, but a relationship between VA and these factors was not found . The data also implied that the ventricular wall movement abnormality and serum potassium level were major risk factors to the development of arrhythmias and the former was an independent risk factor.