动态心电图对心源性晕厥的诊断价值

The value of Holter in the diagnosis of cardiogenic syncope

目的分析动态心电图对心源性晕厥的诊断价值。方法选取2015-03-2019-04郑州大学第二附属医院门诊和病房收治的诊断为心源性晕厥患者89例,同时收集其个人信息及临床资料,所有患者均行动态心电图检查,嘱患者记录佩戴期间的不适症状,采用电脑和人工回放分析记录结果。结果 89例心源性晕厥患者的心电图表现为缓慢性心律失常共34例(38.20%):显著窦性心动过缓伴窦房传导阻滞或窦性停搏13例(14.61%),二度Ⅱ型或三度房室阻滞11例(12.36%),缓慢型心房颤动伴二度以上阻滞10例(11.24%);快速性心律失常共37例(41.57%):频发室性早搏13例(14.61%),阵发性室上性心动过速15例(16.85%),Q-T间期延长伴尖端扭转型室性心动过速(TdP)5例(5.62%),多形性室性心动过速4例(4.49%);其他心律失常18例(20.22%):短Q-T间期3例(3.37%),交替出现左束支及右束支阻滞4例(4.49%),ST段抬高伴缺血型J波2例(2.25%),1型Brugada综合征心电图改变2例(2.25%),起搏器起搏功能不良2例(2.25%),感知功能障碍2例(2.25%),心电图正常或大致正常3例(3.37%)。结论动态心电图可及时发现和明确心源性晕厥,尤其是心律失常性晕厥,早期及时进行动态心电图监测,可明确心源性晕厥的类型或心律失常类型,对于心源性晕厥诊断与治疗具有重要临床指导价值。

Objective To analyze the diagnostic value of Holter in cardiogenic syncope.Methods 89 patients with cardiogenic syncope diagnosed to the outpatients and hospitalized patients from the second Affiliated Hospital of zhengzhou university from March 2015 to April 2019 were selected,and their personal information and clinical data were collected.All the selected patients were examined by dynamic electrocardiogram,and the patients were asked to write down the discomfort symptoms during the examination.Computer was used for manual playback to analyze recorded ECG.Results The ECG of 89 patients with cardiogenic syncope showed:Tardy arrhythmia in 34 cases(38.2%):significant sinus bradycardia with sinus block or sinus arrest in 13 cases(14.61%),degree 2 type Ⅱor degree 3 atrioventricular block in 11 cases(12.34%),slow atrial fibrillation with degree 2 or more severe block in 10 cases(11.24%);Quickness arrhythmia in 37 cases(41.57%):frequent ventricular premature beats in 13 cases(14.61%),supraventricular tachycardia in 15 cases(16.85%),prolonged Q-T interval with torsade tip transition ventricular tachycardia 5 cases(5.62%),pleomorphic ventricular tachycardia 4 cases(4.49%);③short Q-T interval in 3 cases(3.37%),alternating left bundle branch and right bundle branch block in 4 cases(4.49%),ST segment elevation with blood deficiency J-wave in 2 cases(2.25%),ECG changes in type 1 Brugada syndrome 2 cases(2.25%),pacemaker pacing dysfunction in 2 cases(2.25%),perceived dysfunction in 2 cases(2.25%),had normal or roughly normal ECG in 3 cases(3.37%).Conclusion DCG can diagnose cardiogenic syncope in time,especially arrhythmic syncope.Early DCG monitoring can identify the type of cardiogenic syncope or arrhythmic type,which has important clinical guiding value for the diagnosis and treatment of cardiogenic syncope.