病态窦房结综合征的功能检查价值评估及预后

Evaluation of Functional Tests and Prognosis in Sick Sinus Syndrome

目的：探讨病态窦房结综合征（ＳＳＳ）功能检查的价值及治疗方法对预后的影响。方法：９２例ＳＳＳ患者（其中随访６８例）按动态心电图表现分４型，分析功能检查（动态心电图、经食管心房调搏、阿托品试验、固有心率）对各型的临床意义。结果：动态心电图对发作期ＩＩ、ＩＩ、ＩＶ型具有诊断价值。黑或晕厥患者的长间歇时间（３．７７±１．４４秒）显著长于无症状或症状轻者（２．５８±０．３７秒）（Ｐ＜０．００１）；ＩＶ型出现黑或晕厥的发生率较其他各型高（Ｐ＜０．０１）；Ｉ型患者的窦房结恢复时间稍低于其他型（Ｐ＜０．０５）。固有心率测定较阿托品试验更可靠。结论：应根据ＳＳＳ各型特点有目的的选择功能检查。ＩＩ、ＩＶ型患者起搏治疗可减少猝死率。

Objective:To evaluate the functional tests and different treatments on the prognosis of sick sinus syndrome (SSS) patients. Methods:Ninty two patients with SSS (68 of them had follow up studies) were classified into four types according to the findings of dynamic electrocardiogram (DCG).Functional tests (DCG,transesophageal atrial pacing,atropine test,intrinsic heart rate IHR) were evaluated in each group. Results:DCG was diagnostic of types II,III and IV during the attack;sinus pause in DCG test in patients with syncope or presyncope attack lasted 3 77±1 44 s,which was significantly longer than those with minor or without sypmtoms (2 58±0 37 s)( p <0 001)。The incidence of syncope or presyncope was higher in type IV than in the other types( p <0 01).The mean SNRT in type II was significantly shorter than that in the other types;( p <0 05).IHR was more reliable than atropine test for clinical diagnosis. Conclusion:Functional tests should be chosen according to the conditions of patients suspected to have SSS.Sudden death rate could be reduced in types III and IV patients by pacemaker implantation.