动态心电图长RR间期的诊断与临床意义

Quantitative analysis of electrocardiogram diagnosis and clinical significance of long RR interval in ambulatory electrocardiograms

目的分析动态心电图长RR间期的诊断与辅助临床诊断的价值。方法随机抽取24 h动态心电检查患者最长RR间期≥1.5 s的病例为研究对象,采用SAS9.3对数据进行统计分析。结果最长RR间期长度不同心电诊断的疾病不同(P<0.01),多重比较显示,3组间均不同,其中1.5~<2.0 s组中,心电诊断以心律不齐和房早未下传为主;2.0~<4.0 s组中心电诊断以心房颤动为主;≥4 s组中以窦性停搏为主。长RR间期出现的频数不同心电诊断的疾病分布不同(P<0.01),多重比较显示,3组间均不同,其中频数在1~12的心电诊断以心律不齐和房早未下传为主;频数在13~96的心电诊断以心律不齐和心房颤动为主;频数在97以上的心电诊断以心房颤动和窦性心动过缓为主。房早未下传和心律不齐的比重随着长RR间期出现频数的增加逐渐降低,而心房颤动、窦性心动过缓和窦性停搏则相反。Fisher检验显示,睡眠无关比例较大的疾病有心房颤动、心律不齐、房早未下传;其中心律不齐、房早未下传在睡眠相关组中比例也较大。疾病分布以高血压、动脉硬化、冠心病、心房颤动、糖尿病、高脂血症为主;方差分析结果显示,同一患者患上述1种疾病的最长RR间期长度最小(1.75±0.26)s,其次是患有2种疾病的(1.87±0.48)s,3种及以上者的最大(1.98±0.56)s;RR间期频数也存在上述趋势。结论最长RR间期长度越长、长RR间期的频数越高提示临床疾病越复杂。

AIM To investigate the value of long RR interval in clinical diagnosis. METHODS Study subjects were randomly selected from patients with the longest RR interval of no less than 1.5 s from a 24-hour ambulatory electrocardiogram examination and their diagnosis information was recorded. The data were analyzed by Chi-square test, Fisher exact test and variance analysis. RESULTS The varying length of the longest RR interval corresponded to different electrocardiogram （ECG） diagnosis （Fisher test, P 〈0. 0001 ）. Multiple comparison analysis showed that the ECG diagnosis between the three groups were not the same： mainly arrhythmia and nonconducted atrial premature in 1.5 -2. 0 s group, mainly atrial fibrillation in 2.0 -4. 0 s group and mainly sinus arrest in 4 s and above group. Different frequencies of the long RR interval correlated to different ECG diagnoses. Multiple comparison analysis showed that the ECG diagnoses between the three groups were not the same ： the frequency in 1 - 12 were mainly arrhythmia and nonconducted atrial premature, the frequency in 13 -96 were mainly arrhythmia and atrial fibrillation and the frequency in 97 and above were mainly atrial fibrillation and sinus bradycardia. The proportions of nonconducted atrial premature and arrhythmia decreased gradually with increase of the long RR interval frequency, but those of atrial fibrillation, sinus bradycardia and sinus arrest were on the contrary. Fishertest showed that larger proportions of sleep unrelated diseases were atrial fibrillation, arrhythmia and non- conducted atrial premature, while the proportions of the last two diagnoses in sleep related group were also large. The distribution of the disease in the study was mainly high blood pressure, arteriosclerosis, coronary heart disease, atrial fibrillation, diabetes mellitus and hyperlipidemia. The results of variance analysis showed that the longest RR interval was found in patients with three or more kinds of the above diseases （1.98 ±0. 56）, followed by patients with two kinds of the above diseases （1.87 ±0.48） and by patients with one of the above diseases （1.75 ±0.26）. The RR interval frequency had the same trend. CONCLUSION Longer length and higher frequency of long RR interval are associated with the complexity of the disease. Patients with two or more kinds of diseases often have a longer and a higher frequency of the long RR interval, suggesting that the diseases exert an additive or synergetic effect on the heart.