普萘洛尔对T波异常者倾斜试验的影响

The effect of propranolol on T wave abnormalities in tilt test

为探讨Ｔ波异常普萘洛尔（心得安）试验阳性者心脏自主神经功能的变化，对１８例无心脏病（１组）及９例缺血性心脏病（２组）伴ＥＣＧＴ波异常者，在普萘洛尔试验前后进行倾斜试验。并与３０例正常人（３组）对比，分析用药前后ＨＲ和ＥＣＧ。结果：１组倾斜后ＭＨＲ（平均心率）明显高于３组（Ｐ＜００５），服药２小时后倾斜时明显低于用药前（Ｐ＜００１），与３组比无显著性差异；其ＥＣＧ改变多发生于下壁和／（或）前壁导联，倾斜后改变加重，服药２小时后１４例恢复正常，４例部分改善（均包括平卧及倾斜位）。２组倾斜前后ＭＨＲ均与对照组接近（Ｐ＞００５），服药２小时后倾斜ＭＨＲ明显低于用药前（Ｐ＜００５）和３组（Ｐ＜００１）；ＥＣＧ改变多在Ｉ、ａＶＬ导联，倾斜后无加重，部分有改善，服药后均无改善，５例有不同程度加重（包括平卧及倾斜位）。说明Ｔ波异常普萘洛尔试验阳性者存在交感活性增高；单剂量普萘洛尔使ＥＣＧ恢复正常，２组服药后ＥＣＧ变化与前者截然相反，提示倾斜加普萘洛尔试验对缺血性心脏病的临筛选有一定意义。

cases of functional T wave abnormalities (group I) and 9 cases of myocardial ischemia with T wave abnormalities (group Ⅱ) were compared with 30 healthy controls (group Ⅲ) by their MHR (mean heart rate)and ECG changes before and after oral propranolol and Tilt Table Test.The results showed that MHR of group I became significantly faster than that of group Ⅲ(P<0 05),but markedly slowed down two hours after oral propranolol (P<0 01) in standing position,whereas no significance with group Ⅲ.Their T wave inversion most commonly showed in inferoapical leadsⅡ、Ⅲ、aVF and/or V 1～V 6 and aggravated after standing,but recovered in 14 cases and partially improved in the other 4 cases two hours after propranolol (including supine and standing position).The MHR of group Ⅱ were near that of group Ⅲ pre and post standing (P<0 05).It slowed dowm markedly (P<0 05) and more in group Ⅲ(P<0 01)during standing after propranolol. Their T wave often inverted in lead I,aVL and no exacerbation,even partially ameliorate after standing.No improvement appeared at all two hours after oral propranolol,and even became in varing degree, worse in 5 cases (including suoine and standing position).It suggests that T wave abnormalities in these cases are caused by increase in sympathetic activity.Propranolol can correcte it to normal.In ischemic group the results turned into contrary of the former after propranolol.So,the Tilt Table plus Propranolol Test can screen out ischemic heart disease in a certain sence.