动态心电图中三相束支阻滞的特征及意义

Features and significance of phase 3 bundle branch block in Holter

目的 探讨三相束支传导阻滞的发作规律及临床意义。方法 分析 18例病理性三相束支阻滞和 2 0例生理性三相束支阻滞 ,并对病理组 14例随访观察。结果 病理组阻滞时临界心率 5 8～ 12 0次 /min ,其阻滞时R—R间期与基础R—R间期无显著性差异 (t=1.14,P >0 .0 5 )。而生理组阻滞时R—R间期与基础R—R间期有显著性差异 (t =15 .15 ,P <0 .0 0 1) ,具有明显的长—短周期。病理性三相左束支阻滞 7例中 5例 (71% )转为永久性 ,右束支阻滞 11例中 4例 (36 % )转为永久性。结论 间歇性束支阻滞其不应期病理性延长 ,一部份转为永久性束支阻滞 ,其发生与基础心脏病有关。而生理性阻滞束支不应期正常 ,其本身无病理意义。

Objective\ To explore the rules and clinical significance of phase 3 bundle branch block.Methods\ The pathologic phase 3 bundle block in 18 cases and the physiologic block in 20 cases were comparatively analyzed.Results\ In the physiology group,the block R-R intervals had obvious long-short cycles and there were significant differences between the block R-R intervals and the primary ones.On the contrary,in the pathology group,the block R-R intervals were not significantly different from the primary R-R intervals.The critical heart rates were 58 to 120 times/minute.Five of seven(71%)cases of phase 3 left bundle branch block and four of eleven (36%) cases of phase 3 right bundle branch block became permanent block.Conclusion\ In pathologic bundle branch block,prolongation of refractory period is caused by primary heart diseases.The block becomes permanent in some patients,While the refractory period is normal in physiologic block.