非交替性文氏周期房室交接区双层阻滞的心电图与临床分析

Electrocardiography feature of non-alternating Wenchebach atrioventricular double layer block and it's clinical significance

目的探讨表现为非交替性文氏周期的房室交接区双层阻滞的心电图特点和临床意义。方法回顾性分析表现为非交替性文氏周期的房室交接区双层阻滞的10例器质性心脏病患者的临床资料。结果10例心电图改变为伴长P-R间期文氏现象(A型)及伴长P-R间期高度房室传导阻滞(B型)各5例。其中9例出现于窦性心律,1例由药物所致者出现于房性心动过速。加用异丙肾上腺素治疗4例(2例消除,1例减轻,1例无效而安装心脏起搏器);未加用异丙肾上腺素治疗5例(2例消除、3例减轻)。所有病人均获临床治愈或好转出院。结论非交替性文氏周期亦为房室交接区双层阻滞的常见类型。B型与A型同样多见。绝大多数出现于窦性心律,且均为病理性房室传导阻滞。治疗原则与单一类型房室传导阻滞无异,对有症状的二度或更严重的房室传导阻滞可应急加用异丙肾上腺素治疗,但对预后并无显著影响。

Objective To explore electrocardiogram feature of non-alternating Wenchebach atrioventricular double layer block and it＇s clinical significance. Methods Clinical data of 10 patients with non-alternating Wenckebach atrioventricular double layer block were analyzed retrospectively. Results 5 cases showed Wenchebach atrioventricular block with long P-R interval（type A） and 5 cases showed high degree atrioventricular block with long P-R interval（type B）. Of them, 9 cases developed atrioventricular block during sinus rhythm and another one during atrial tachycardia induced by medication. 4 cases were treated with isoprenaline （2 cases recovered, one case eased, another one needed pacemaker implantation） and 5 cases were not treated with isoprenaline （2 cases recovered and 3 cases eased）. Conclusion Non-alternating Wenckebach period is a common manifestation of atrioventricular double layer block. Most of them occur during sinus rhythm and are pathological atrioventricular block. Treatment principle of them is as same as that of simple atrioventricular block. Isoprenaline may be tried to manage patients with serious atrioventricular block and symptoms but has no significant impact on prognosis of disease.