无器质性心脏病室性早搏昼夜变化与植物神经功能的研究

Investigation of the autonomic nervous system function of ventricular premature contraction without underlying organic heart diseases

目的 了解儿童无器质性心脏病室性早搏 (VPC)的昼夜变化、与植物神经功能紊乱的关系及预后。方法 对 4 0例无器质心脏病室性早搏患儿进行 2 4h动态心电图、植物神经功能检查、频谱心电图及心室晚电位等检查 ,并定期随访心电图等。结果 (1)动态心电图 :4 0例VPC中 ,日间型 11例 (2 7 5 % ) ,夜间型 8例 (2 0 0 % ) ,混合型 2 1例 (5 2 5 % )。 (2 )植物神经功能检查结果 :11例日间型VPC中 8例有交感神经功能亢进 ,8例夜间型均有迷走神经功能亢进 ,2 1例混合型中 3例交感神经功能亢进 ,2例迷走神经功能亢进。 (3)随访无 1例有晕厥和死亡。结论 儿童无器质性心脏病室性早搏部分与植物神经功能失衡有关 ,室性早搏呈昼夜变化 ,日间型多为交感神经功能亢进 ,夜间型多为迷走神经功能亢进 ,心电图多数为单源早搏 ,少数为复杂VPC 。

Objective To investigate the relationship between day and night regularity of ventricular premature contraction(VPC) without organic heart diseases,activity of autonomic nervous system and prognosis.Methods Fourty children without apparent heart disease were examined with 24 h dynamic electrocardiogram(DCE),the function of autonomic nervous system,high frequency ECG (HEFCG)and ventricular late potential(VLP).Follow up information was collected.Results (1)DCG:of 40 children with VPC,11(27.5%)were the day type VPC,8(20.0%)were the night type,21(52.5%)were the PLmixed type.(2)The function of autonomic nervoux system:8 patients were increased activity of sympathetic nerve in 11 of the day type;all patients were enhanced activity of vagus nerve in 8 of the night type;of 21 children with the mixed type,3 increased activity of sympathetic,2 enhanced activity of vagus nerve and 16 no sympathetic or vagus nervous enhancing.(3)Follow up results:none had syncope and sudden death.Conclusion VPC of children without organic heart disease is partly correlated to the function of autonomic nervous system,and has the day and night regulation,that the day type as sympathetic enhancing,the night type as vagus nervous enhancing.There are the most number of single uniform VPC and a small number of multiform VPC.Prognosis appears benign,and therapy with anti arrhythmia drugs for VPC is not necessity.