儿童室性并行心律和室性早搏的动态心电图分析

Clinical analysis of dynamic electrocardiography of ventricular parasystole and ventricular premature beat in children

目的观察儿童室性并行心律和室性早搏的特点并探讨临床意义。方法回顾78例儿童室性心搏的动态心电图资料,以时间散点图和Lorenz-RR散点图的图形特征并结合逆向心电图进行诊断,分为室性并行心律(室并组,n=43)和室性早博(室早组,n=35),并对早搏起源进行定位。统计并分析两组在总心搏数、室性心搏数、心律失常指数以及心率变异性有无差异。结果在两组中,室性心搏起源于左室者较右室者均显著增多(42例vs 1例,22例vs 13例,P<0.05)。室并组的总心搏数显著高于室早组[(164 655±4 586)次/分vs(146 656±4 773)次/分,P<0.001]。与室早组比较,室并组反映交感活性指标[SDANN:(65.79±3.45)ms vs(105.81±7.69)ms]以及迷走活性指标[rMSSD:(23.86±2.16)ms vs(46.81±4.1)ms;PNN50:(0.1599±0.02)vs(0.05±0.01);HF:(317.11±103.47)vs(1 663.45±275.03)],均显著降低。结论室性并行心律的起搏点大部分来源于左室,室性并行心律在儿童中多为良性。

Objective To observe the characteristics of ventricular parasystole and ventricular premature beat in children and to explore their clinical significance. Methods The dynamic electrocardiograms of 78 children with ventricular beats were analyzed retrospectively.With a combination of Lorenz-RR scatter plot,time-RR-interval scatter plot and the reversal technique,the diagnosis was made and the origin of premature beat was analyzed.Dates were divided into two groups：ventricular parasystole（group A,n=43）and premature ventricular contraction（group B,n=35）.Moreover,total heart beats,total ventricular beats and arrhythmia index were counted,heart rate variability（HRV）was analyzed. Results In both of group A and group B,ventricular premature contractions originating from left ventricular were significantly more than that from right ventricular（42 cases vs 1 cases,22 cases vs 13 cases,P0.05）.The total heart beats of group A was significantly higher than that of group B[（164 655±4 586）bpm vs（146 656±4 773）bpm,P=0.011].The HRV in group A：including indexes reflecting sympathetic activity[SDANN：（65.79±3.45）ms vs（105.81±7.69）ms]and vagal activity[rMSSD：（23.86±2.16）ms vs（46.81±4.1）ms;PNN50：（0.1599±0.02）vs（0.05±0.01）;HF：（317.11±103.47）vs（1663.45±275.03）]was significantly lower than that in group B（P0.0001）. Conclusion The pacemakers of most ventricular parasystole are from left ventricular,and ventricular parasystole is mostly a benign arrhythmia.