脊髓损伤康复期患者窦性心动过缓调查及治疗策略探讨

Survey and treatment strategy on sinus bradycardia of patients with spinal cord injury

目的:通过病例回顾性调查来了解脊髓损伤患者窦性心动过缓的发生率,探讨这一特殊人群可能的心律失常风险及治疗策略。方法:对中国康复研究中心2004年1月～2009年12月年因脊髓损伤入院进行康复治疗的1 831例患者(男1 470例,女361例)进行入院后静息心电图调查,并记录心率及心律失常类型。结果:颈脊髓损伤患者平均心率显著低于胸腰段脊髓损伤患者(男:67次/min vs 74次/min,女:67次/min vs 76次/min,P<0.01),窦性心动过缓发生率显著升高(男:34%vs 10%,女:29%vs 8%,P<0.01)。结论:脊髓损伤康复期患者中,窦性心动过缓主要发生于颈脊髓损伤患者。目前长期药物治疗效果尚不清楚,对难治性、持续性严重心动过缓者起搏器治疗可能是有益的选择。需要进一步循证医学证据支持。

Objective： To investigate on sinus bradycardia of patients with spinal cord injury（SCI） and try to find the possible risk and therapeutic strategy for them.Methods： ECG characteristics of 1 831 chronic SCI patients（including 1 470 men and 361 women） for rehabilitation therapy in China Rehabilitaion Research Center（CRRC） from January 2004 to December 2009 were investigated,their heart rate and the type of arrhythmia were recorded.Results： The heart rates of patients with cervical spinal cord injury（CSCI） were lower than that of the patients with thoracic and lumbar SCI（TLSCI）（men： 67 times per minutes vs 74 times per minutes,women： 67 times per minutes vs 76 times per minutes,P0.01）,the rate of sinus bradycardia（men： 34% vs 10%,women： 29% vs 8%,P0.01） were higher than those with thoracic and lumbar SCI（TLSCI）.Conclusion： Patients with CSCI showed significantly higher prevalence of sinus bradycardia than those with TLSCI.Long term effects of medical treatment for the patients are unclear.Permanent cardiac pacemaker should be strongly considered in severe patients with refractory or recurrent sinus brady-arrhythmia.It needs further support from evidence-based medicine.