妊娠期室性心律失常发生的类型与心率变异性的关系

The relationship between the type of ventricular arrhythmia and heart rate variability during pregnancy

目的:观察孕妇室性心律失常中室性并行心律和室性期前收缩的动态心电图特点(DCG),并探讨其对心率变异性(HRV)的影响。方法:回顾210例室性心律失常及33例正常孕妇的DCG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,并对期前收缩起源进行定位,分为左、右室起源。依据DCG定位将患者分为室性期前收缩组(左室组、右室组)59例、室性并行心律组(左室组、右室组)151例和对照组33例,比较各组总心搏数、室性期前收缩数、心律失常指数以及HRV、交感活性和迷走活性方面的差异。结果:妊娠期室性心律失常患者的总心搏数较健康对照者增多(P<0.05)。室性并行心律组室性期前收缩数较室性期前收缩组多(P<0.05),但两组在起源点方面的差异并无统计学意义。室性并行心律组与室性期前收缩组HRV相关指标均低于对照组(均P<0.05);室性并行心律组各项指标较同侧心室来源的室性期前收缩组明显下降(均P<0.05)。结论:妊娠期室性心律失常者的HRV指标均有所下降,其中右室起源的室性并行心律HRV指标下降更明显;室性期前收缩的构成比高于室性并行心律,二者的发生可能与自主神经功能改变或妊娠期生理变化相关。

Objective：To observe the dynamic electrocardiogram（DCG）characteristics of ventricular parasystole（VPSR）and ventricular premature beat（PVB）in pregnancy,and to explore its effect on heart rate variability（HRV）.Method：The DCG data of 210 cases of pregnant women with ventricular arrhythmia and 33 cases of normal pregnant were analyzed retrospectively.With a combination of Lorenz-RR scatter plot,time-RR-interval scatter plot and the reversal technique,the diagnosis was maded and the origin of premature beat can be divided into left and right ventricular source.Included cases were divided into VPSR group（left ventricular subgroup,right ventricular subgroup）（n=151）,PVB group（left ventricular subgroup,right ventricular subgroup）（n=59）and control group（n=33）,the difference of total number of heart beats,ventricular premature contractions number,arrhythmia index,sympathetic activity and vagal activity between each groups was analyzed.Result：The tatol number of heart beats was significantly increased in VPSR and PVB group than that in control group（P〈0.05）.The number of ventricular premature contractions in VPSR group was more higher than than in PVB group（P〈0.05）,but there was no difference in the origin.Indexes of HRV in VPSR and PVB group were both decreased compared with those in control group（all P〈0.05）,HRV indexes of same ventricular origin in VPSR group were lower than those in PVB group（all P〈0.05）.Conclusion：The HRV of patient with ventricular arrhythmia are declined,which in VPSR the right ventricle is more obvious.The occurrence of PVB is higher than that of VPSR,which is related to the change of autonomic nerve function or the physiological changes during pregnancy.