房室交界区双层阻滞的心电图改变与临床

Electrocardiography feature and clinical manifestation of atrioventricular junctional double layer block

目的进一步认识和评价房室交界区双层阻滞的心电图改变和临床意义。方法分析696例房室阻滞中10例房室交界区双层阻滞的资料。结果10例患者均为器质性心脏病,心电图均表现为非交替性文氏周期,其中长PR间期文氏现象(A型)及长PR间期高度房室阻滞(B型)各5例。9例出现于窦性心律,1例因药物导致房性心动过速。经异丙肾上腺素治疗4例,其中2例双层消除,1例减轻,1例因治疗无效而植入心脏起搏器;5例未用异丙肾上腺素治疗,其中2例双层阻滞消除,3例减轻。10例患者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界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,且均为病理性房室阻滞。治疗原则与单一类型房室阻滞无异,对有晕厥等症状的高度或二度房室阻滞可加用异丙肾上腺素治疗,但对预后并无显著影响,仅作为应急和过渡措施。

Objective： To understand and evaluate electrocardiography feature and clinical manifestation of atrioventricular junctional double layer block. Methods Clinical data of 10 patients with atrioventricular junctional double layer block from 696 patients with atrioventricular block were analyzed. Results All 10 cases have organic heart disease and their electrocardiography feature showed nonalternating Wenchebach period. 5 cases showed Wencilebach atrioventricular block with long PR interval （type A） and 5 cases showed high degree atrioventricular block with long PR interval （type B）. 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 of them recovered, one case eased and another one needed pacemaker implantation. 5 cases were not treated with isoprenaline. 2 cases of them recovered and 3 cases eased. All 10 cases were cured or discharged with better condition. Conclusion Nonalternating Wenchebach period is a common manifestation of atrioventricular junctional double layer block. type B is as common as type A. Most of them occur during sinus rhythm and are pathological block. Treatment principle of them is as same as that of simple atrioventricular block. Isoprenaline may be tried to manage patients with high degree or second degree atrioventricular block and symptoms but has no significant impact on prognosis of disease.. Isoprenaline is only used with emergency and temporary condition.