老年动态心电图长R-R间期的临床分析

Clinical Analysis of Long R-R Interval in Dynamic Electrocardiogram of the Aged

目的:探讨老年动态心电图(DCG)长R-R间期的临床意义。方法:伴明显胸闷、头晕、黑矇或晕厥的228例老年人为A组,同期伴同样症状146例中年人为B组,回顾性分析2组患者的临床心电图资料。结果:A组冠心病(54.8%)和病态窦房结综合征(9.7%)发生率明显高于B组(35.6%和3.4%,P<0.01,P<0.05);A组最慢心率(39.1±6.3)次/min明显低于B组(45.2±9.6次/min,P<0.01),A组心率<40次/min(57.9%)明显高于B组(25.3%,P<0.01);导致DCG长R-R间期A组持续性心房纤颤(46.9%)明显多于B组(28.8%,P<0.01);A组和B组长R-R间期均多见于4000ms以内;A组长间期活动状态时(45.6%)与休息时(54.4%)比较,差异无统计学意义(P>0.05);符合植入起搏器指征者A组(27.6%)植入永久性起搏器高于B组(17.1%,P<0.05),2组起搏器植入后在药物治疗配合下症状均改善(P>0.05)。结论:老年人DCG检测出长R-R间期以冠心病和病态窦房结综合征持续性心房纤颤最多见,时限多在4000ms以内,与活动状态无明显相关性,永久性起搏器植入是老年人有效的治疗方法。

Objective：To explore the clinical significances of long R-R interval in dynamic electrocardiogram （DCG） of the aged. Methods：Two hundreds and twenty-eight aged patients experienced obvious chest tightness,dizziness,amaurosis or syncope were assigned into group A and 146 middle-aged patients with the same symptoms in the same period were assigned into group B. Clinical data of DCG was analyzed retrospectively. Results：The incidence of coronary heart disease （CHD） （54.8%） and sick sinus syndrome （SSS） （9.7%） were obviously higher in group A than those in group B （35.6% and 3.4%,P〈0.01,P〈0.05）; the slowest heart rate （39.1±6.3） beats per minute （bpm） were obviously lower in group A than that in group B （45.2±9.6） bpm （P〈0.01）,and the slowest heart rate 40 bpm accounted for 57.9% were obviously higher than that in group B （25.3%,P〈0.01）. There were more long R-R intervals in DCG caused by persistent atrial fibrillation in group A （46.9%） than those in group B （28.8%,P〈0.01）; the long R-R intervals were more commonly less than 4000 ms （P〈0.05） in both groups; in group A,long R-R interval occurred in activities was 45.6%,at rest was 54.4%,the difference has no statistical significance （P〉0.05）; In group A,27.6% patients met indication of permanent pacemaker implantation which was higher than that in group B 17.1 % （P〈0.05）,patients＇ symptoms were improved in both groups with medicine treatment after permanent pacemaker implantation（P〉0.05）. Conclusions：Long R-R intervals detected in DCG of the aged were most common in persistent atrial fibrillation caused by CHD and SSS,and the time was more commonly less than 4 000ms,and also had no obvious correlation with activities,permanent pacemaker implantation was an effective treatment for the aged.