动态心电图对老年人右束支阻滞监测的临床意义

The Clinical Significance of Dynamic Electrocardiogram in Elderly Patients with Right Bundle Branch Block

目的探讨动态心电图（dynamic electrocardiogram,DCG）对老年人完全性右束支阻滞（complete right bundle branch block,CRBBB）监测的临床意义.方法选择12导联常规心电图符合CRBBB诊断标准的患者共361例,其中男254例,女107例,根据患者年龄将其分为3组：1组年龄〈60岁,2组年龄60-74岁,3组年龄≥75岁.采用DCG分析系统对3组患者进行监测,分析比较心律失常的发生.结果 3组患者的性别构成比中CRBBB的发生率男性均多于女性,有统计学意义（P〈0.01）;临床疾病病种种类比较：冠心病及高血压的发生2组3组均多于1组,糖尿病3组发生最多,P〈0.05.心律失常比较：房性心律失常（频发房早、短阵及阵发性房性心动过速）及室性心律失常（II、IVA、IVB级）的发生3组均高于1组或/和2组,P〈0.05;3组患者合并A-VB共21例,其中12例安置了永久起搏器;发生交界性逸搏心律3组患者最多,有统计学差异,P〈0.05.提示CRBBB发生男性多于女性,随年龄增加冠心病、高血压及糖尿病的发生率增高,CRBBB的发生率也随之增加,合并房性、室性心律失常及房室传导阻滞的发生也随之增多.结论 DCG监测对老年人CRBBB合并心律失常的发生、起搏器的植入及预测发展有着重要的评估意义.

Objective To explore the clinical significance by monitioring Dynamic Electrocardiogram in elderly patients with Complete Right Bundle Branch Block.Methods 12 channel ECG with a totle of 361 cases,were selected,among whom 254 cases were males and 107 cases females.According to the age,the patients were dvided into three groups：group 1 were less than 60 years old,group 2 were between 60∽74 years old,and group3 were more than or equal to 75 years old.DCG analysis system for monitoring patients were used in the three groups so as to compare the occurrence of arrhythmia analysis.Results In the constituent ratio of the incidence of CRBBB,male patients were more than that of female patients in the three groups of gender, there was significant difference（P〈0.01）; Comparison of clinical disease type：The incidence of coronary heart disease and hypertension in both group 2 and group 3 were more than that of group 1,while group 3 had the most diabetes, P〈0.05.Comparsion of cardiac arrhythmias ：atrial arrhythmia（frequent atrial premature beat,a short array and paroxysmal atrial tachycardia） and ventricular arrhythmia（II 、IVA、IVB Level） occurred in group 3 were higher than that of group 1 and / or group 2,P〈0.05.Three groups of patients with a total of 21 cases of AVB,among the 12 cases of placement of a permanent pacemaker;groups 3 of patients with Junctional escape rhythm occurred most frequently,and there was a significant difference,P〈0.05.It was proved that CRBBB occurred more in male than in female patients.With the increase of age, the rate of coronary heart disease, hypertension disease, diabetes mellitus and the incidence of CRBBB also increased,and so do combined with atrial,ventricular arrhythmias and atrioventricular block.Conclusions There is an important significance of evaluation and forecast on the development of DCG implcntation to monitor the elderly CRBBB with the occurrence of arrhythmia and pacemaker.