慢性心力衰竭伴室性心动过速患者窦性心率震荡现象的临床观察

Clinical observation of heart rate turbulence in chronic heart failure patients with ventricular tachycardia

目的观察窦性心率震荡(HRT)现象在慢性心力衰竭(简称心衰)伴室性早搏(简称室早)或室性心动过速(VT)患者中的临床特点。方法 65例心衰患者分为室早伴VT组(n=35),单纯室早组(n=30),并以36例具有室早的健康人为对照组,观察分析震荡初始(TO)和震荡斜率(TS)两指标及依HRT改变程度对其进行分级的临床评估。结果与对照组比较,室早伴VT组和单纯室早组TO明显增大(0.439%、0.022%vs-1.658%,P<0.01),TS明显变小(1.628 ms/RRI、2.465 ms/RRI vs 7.622 ms/RRI,P<0.01);与单纯室早组比较,室早伴VT组的TO增大,而TS明显变小(P<0.05)。HRT 0级集中分布于对照组(86.1%),HRT 1级以单纯室早组居多(60%),HRT 2级则以室早伴VT组多见(68.6%)。结论心衰患者HRT明显减弱或消失,合并VT者其HRT的减弱程度较仅伴室早者更加显著,HRT分级能够较好地反映HRT损伤的不同程度。

Objective To observe the clinical characteristic of heart rate tubulence （HRT） in chronic heart failure （CHF） patients with premature ventricular contraction （PVC） or ventricular tachycardia （VT）. Methods Sixty-five CHF patients were divided into PVC with VT group （ n = 35 ） and only PVC group （ n = 30 ）. Thirty-six healthy persons with PVC were control group. Turbulence onset （TO） and turbulence slope （TS） were observed and analyzed, the grade according to the degree of change in HRT were clinically assessed. Results Compared with control group, TO in PVC with VT and only PVC group distinctly increased （0. 439% ,0. 022% vs -1. 658%, P〈0.01 ）, TS obviously decreased （1. 628 ms/RRI,2. 465 ms/RRI vs 7. 622 ms/RRI, P〈0. Ol ）. TO in PVC with VT group increased comparison with only PVC group, but TS obviously decreased （ P〈0. 05 ）. HRT 0 level concentrated in control group （ 86.1% ）, HRT 1 level was the majority in only PVC group （60%）, HRT 2 level was more common in PVC with VT group （68.6%）. Conclusion HRT is significantly blunted or disappeared in CHF patients, weak degree of HRT in patients with VT is more significant than it in patients with only PVC, HRT grading can better reflect the HRT injury of different degree.