动态心电图对缓慢心律失常有起搏适应证的研究

Study on the value of DCG to indications of heart pace maker treatment for bradyarrhythmia

目的采用动态心电图(DCG)对缓慢心律失常进行监测,分析临床症状与缓慢心律失常是否有关,评价DCG在永久起搏治疗缓慢心律失常时的心电学指标。方法随机选择临床常见的缓慢心律失常且有DCG资料者86例,以治疗适应证分为3组:①组:窦房结功能障碍(SSS)34例;②组:获得性房室阻滞(AVB)33例;③组:双分支及三分支阻滞19例。对3组24h总心搏,最大、最小及平均心率,长R-R间距,逸搏心律,心脏变时功能(24h最大心率<120次/分为变时性功能不全)等进行分析。通过随访分析安装及未安装起搏器的原因。结果 3组相比最大心率及长R-R间距差异无显著性,①组和③组相比总心跳、平均及最小心率差异有显著性(P<0.05)。最小心率:①组和②组相比差异无显著性,但②组和③组相比差异有显著性(P<0.05)。在①组中,发生晕厥4例,>3.00s的长R-R间距11例,最长R-R间距为5.45s;休息时心率<40次/分8例;慢快综合征11例;变时性功能不全26例,多为IC类和ⅡaC类适应证患者。在②组中,三度及高度AVB者8例,发生>5s的长R-R间距5例;2:1AVB者7例,双结病变2例,二度Ⅰ型AVB者16例,多为IC及Ⅱa、bC类适应证患者;在③组中间歇性三度AVB者7例,双分支伴2:1AVB者4例,交替性左右束支阻滞5例;三分支阻滞3例,最长R-R间距为13.00s,多为IB类和IC类适应证患者。起搏器安装情况:86例共安装起搏器48例(55%),主要为IB、C类适应证患者。结论 DCG能记录缓慢心律失常的详细情况,尤其是能提供导致发生症状的缓慢心律失常类别,对安装起搏器适应证的分类做出判断,为临床治疗提供可靠的、有价值的依据。

Objective To analyze the value of DCG to indications of heart pace maker treatment for bradyarrhythmia.Methods 86 patients with bradyarrhythmia were divided into 3 groups：Group A：34 cases with sinus node dysfunction（SSS）;Group B：33 cases with acquired atrioventricular block （AVB）.Group C：19 cases with bisfascicular block and trifascicular block（BBB）.Total heart beats,maximum heart rate,minimum heart rate.average heat rate,long R-R interval,escape beat and chronotropic incompetence （CI） were analyzed.Results There was no distinct difference in maximum heart rate and long R-R interval among three groups;there were distinct differences in total heart beats,minimum heart rate and average heat rate between Group A and Group C （P〈0.05）.There was no distinct difference between Group A and Group B,and was difference Group B and Group C （P〈0.05） in minimum heart rate.Conclusion DCG can record the detailed information related to bradyarrhythmia.