从动态心电图角度探讨室性早搏的临床意义

Clinical Study of Ventricular Premature Beats by Dynamic Electrocardiogram in 575 Cases

对２４小时动态心电图（ＤＣＧ）检出有室性早搏（ＰＶＢｓ）的５７５例进行分析。分为器质性心脏病组（Ⅰ组）和无器质性心脏病证据组（Ⅱ组），两组分别为３６７例和２０８例。结果显示≥ＬｏｗｎⅢ级以上的复杂性ＰＶＢｓ和≥３０次／小时的频发性ＰＶＢｓ发生率以Ｉ组明显为高，且又以心肌梗塞、扩张性心肌病、急性心肌炎为突出。Ⅰ组中７３例伴有充血性心力衰竭（ＣＨＦ），其复杂性ＰＶＢｓ又显著高于心功能正常者，频发性ＰＶＢｓ的发生率与心功能无明显关系。４７例同时检出室性心动过速（ＶＴ）共１４１阵次，其发生率Ⅰ组高于Ⅱ组，均呈短阵发作，自行终止。ＶＴ发作前多呈成对和／或多源形式出现。检出有ＲｏｎＴ或ＲｏｎＰ现象５６例，ＲｏｎＰ现象Ⅰ组明显多于Ⅱ组。ＲｏｎＴ现象在两组间检出率无明显差异。由ＲｏｎＰ现象诱发的成对ＰＶＢｓ或短阵ＶＴ远多于ＲｏｎＴ者。同时伴发其他心律失常或传导障碍Ⅰ组也多于Ⅱ组。本文认为，复杂性及频发性ＰＶＢｓ和短阵室速以器质性心脏病者多发并与其心脏病变的严重程度和／或心功能状态有关。多源与／或成对ＰＶＢｓ同ＶＴ发生有密切联系，表明ＰＶＢｓ的Ｌｏｗｎ分级对室性早搏的病理意义判定仍有一定价值，但并不完全，本组有１／３的频发或?

The ventricular premature beats(PVBs)examined by 24 hdynamic electrocardiogram( DCG)in 575 cases were analysed. According to clinical data, they were divided into two groups: group 1(367 cases with cardiac disease) and group 2(208 cases without cardiac disease)The incideceof the complicated PVBs(≥Lown′ s gradeⅢ)and frequent PVBs(≥30 beats/h)in group l especially in cases with congestive heart failure(CHF),dilated cardiomyopathy and acute myocarditis, was much higher than hat in group 2. In group l,the incidence of complicated PVBs in 73 cases with CHF was much higher than the cases with normalcardiac function,however, the incidence of frequent PVBs had no obvious relation to the cardiac function. 141 episodes of ventriclar tachycardia(VT ) were found in 47 cases,most of which began as paired and multifocally and occurred as short paroxysmally,stopped spontaneouslly. RonT or RonP phenomena were detected in 56 cases. RonP phenomena in group l as well as the other complicated arrhythmia or conduction disturbance occurred much more than group 2, however the detectable rate of RonT phenomena between two groups had no significant difference. In addition,the paired PVBs or short paroxysmal VT induced by RonP phenomena occurred much more than that induced by RonT.Weconcluded that the complicatd and frequent PVBs and paroxysmal VT occurred more in the cases with cardiac diseases than the cases without cardiac diseases and had relation tothe severity and/or cardiac function of the cases. The multifocal and/or paired PVBs had close relation to VT which indicated PVBs and Lown′s classification was of certain value to the judgement of pathological significance of PVBs. However,one third ofthe frequent or complicated PVBs had no proof of the cardiac disease and a few of VT and RonT phenomena occurred in group Ⅱ. VT induced by RonP occurred much more than RonT ,indicating that RonP phenomena was of much clinical importance.