食管信号平均窦房结电图在部队伤病员中的应用

Experimental and Clinical Study of Sinus Node Electrogram by Transesophageal Signal Averaging Technique in Military Patients

探讨无创性经食管信号平均直接记录窦房结电图(SNE)的技术。在8只犬进行了系列实验研究的基础上,又对1289例食管电生理检查窦房结传导时间(SACT)和窦房结恢复时间(SNRT)均在正常范围的部队伤病员,男968例、女321例,年龄47.6±12.6(10-86)岁进行检测,其中256例进行了心内有创SNE的记录。采用自制三导心电微电位检测仪将食管导联的信号放大(增益达到100uV/cm)、滤波(0.1-50Hz),16位模/数(A/D)转换,系统采样频率2 kHz,对信号进行叠加,1 1 08例(86%)记录到食管SNE。所测信号平均食管SNE为P波前的低幅、低频波,可见有两种形态:园顶型(62%)和上斜型(38%)。所测窦房传导时间为83.6±26.5 ms,与有创心导管记录的窦房结传导时间(80.4±18.1 ms)相一致,分布范围为23—1 18ms;波幅为3.5—27.7uV;dv/dt为0.43—1.93mV/s。结论为在适当的滤波、高增益和抗基线漂移技术条件下,利用经食管信号叠加技术,大多数窦房结功能正常的患者可直接记录到食管SNE。

Develop a noninvasive transesophageal signal averaging technique for direct recording of sinus node electrogram. 1289 Military patients were recorded. 968 were male and 321 were female, aged from 47.6±12.6 （10-86） year. The signals from lead I, surface averaged lead and esophagus averaged lead were amplified （up to 100 μV/cm）, filtered （0.1 - 50Hz）, AD converted to 16-bit accuracy at a sampling rate of 2kHz and averaged by using the three-channel low-noise amplifier. In order to verify the reality of sinus node potentials recorded by esophageal lead, electric activities of esophagus/sinus node area and right atrium are simultaneously recorded by intracardiac direct record method in man and in dog. Sinus node electrograms were recorded from 1108 of 1289 patients （86%）. The signal averaged esophageal sinus node potentials were deflections of low-amplitude and low-frequency preceding the P wave. Two morphologies, the domed wave （687 of 1108 patients, 62%） and the smooth upstroke slope （421 of 1108 patients, 38%）, can be seen. The directly recorded sinoatrial conduction time was 83.6 ± 26.5 ms （mean ＋ 2SD）, ranged from 23 to 118ms, amplitude was 3.5 -27.7 μV and dv/dt was 0.43- 1.93mV/s. The sinoatrial conduction time recorded by the transesophageal catheter technique was comparable to that （80.4±18.1ms） recorded by the transvenous catheter method perfectly. Signal averaged sinus node electrogram could recorded in sinus rhythm in most patients with normal sinus node function and proper filter settings, high amplification and anti-drift technique are important in recording signal averaged esophageal sinus node electrogram.