恢复期亚急型和慢型克山病患者动态心电图特点及预后意义

The clinical features and prognostic meanings of dynamic electrocardiogram on recover-term subacute and chronic Keshan disease

目的观察恢复期亚急型和慢型克山病患者动态心电图(DCG)特点,探讨其预后意义。方法选择恢复期亚急型和慢型克山病患者88例,进行心电图(ECG)和DCG检查,并长期随访,以观察终点结果死亡或存活分组对比分析。结果恢复期亚急型克山病患者在ECG 90.3%正常情况下,84.9%的DCG出现异常。慢型ECG及DCG异常检出率都很高,分别为94.7% 和100.0%。亚急型DCG异常检出率室早最高,为77.4%,其中成对室早51.6%,室速32.3%;房早次之41.9%。慢型DCG异常检出率室早最高,为96.5%,其中频发室早75.4%,成对室早51.6%,室速32.3%;房早次之82.2%。死亡组与存活组对比,死亡组ECG房早、室早、ST鄄T改变较存活组检出率高(P<0.05)。死亡组与存活组DCG室早总检出率无差异(P>0.05),但成对室早和室速检出率较存活组高(P<0.05)。结论房性与室性心律失常是恢复期亚急型和慢型克山病的DCG特征,亚急型ECG正常,DCG高异常检出率;慢型ECG及DCG均高异常检出率。成对室早和室速对预后有重要意义。

Objective To observe the clinical features and to explo re prognostic meanings of dynamic electrocardiogram on recover-term subacute and chronic Keshan disease. Methods Thirty-one recover-term subacute patents and 57 chronic Keshan patents were selected from Shandong epidemic area of Keshan disease. They were checked up by electrocardiogram （ECG） and dynamic electrocardiogram （DCG） and were followed-up for long term. All patents were divided into 2 groups （survive and death groups）, which were analysed by comparative methods. Results Normal ECG was 90.3% and subnormal DCG was 84.9% in recover-term subaeute patents. The incidence rate of subnormal ECG and DCG were all high in chronic Keshan disease. The incidence rate of ventrieular premature was 77.4%, frequent ventrieular premature 25.8%, pair ventrieular premature 51.6%, ventrieular taehyeardia 32.3% in subnormal DCG of recover-term subacute patents. The incidence rate of ventricular premature was 96.5%, frequent ventricular premature 75.4% , pair ventricular premature 77.2%, ventricular tachycardia 59.6%, atrial premature 82.2% in subnormal DCG of chronic patents. The subnormal DCG on survive groups was compared with death groups.The incidence rate of atrial premature, ventricular premature and ST-T change in subnormal ECG of were higher than that in survive groups （P 〈 0.05） . The incidence rate of frequent ventrieular premature, pair ventrieular premature and ventrieular taehyeardia of DCG in death groups were higher than that in survive groups （P 〈 0.05）. Conclusions The atrial and ventricular cardiac arrhythmia are the features of ECG and DCG in reeover-termsubacute and chronic Keshan disease. ECG is normal , DCG subnormal in recover-term subacute patents but ECG and DCG are all subnormal in chronic patents. The pair ventricular premature and ventricular tachycardia are important for prognosis.