儿童迷走神经活动增强性心电图变化的意义

The significance of electrocardiographic changes in children with vagus nerve excitability enhancement

目的 对迷走神经活动增强所致的部分心电图改变进行记录方式和临床意义的探讨。方法 对 2 81例普通心电图记录为游走性心律、交界性心律、Ⅰ度和Ⅱ度Ⅰ型房室传导阻滞的小儿经改变体位、运动、阿托品试验后描记的心电图进行分析。结果 经体位变化后心电图恢复正常者 176例 ,运动后正常者 61例 ,阿托品试验后正常者 3 0例 ,总恢复正常率 95% (2 67/ 2 81)。经以上方法仍无变化者 14例。其中 14 7例随访临床及心电图 6个月～ 3年 ,全部病例未经抗心律失常药物治疗临床情况良好。结论 建议对普通心电图记录时发现的游走性心律、交界性心律、Ⅰ度及Ⅱ度Ⅰ型房室传导阻滞 ,只要小儿一般情况良好 ,均应常规加做体位变化、运动或阿托品试验后心电图。对即时恢复正常窦性心律 ,房室传导阻滞消失者应视为迷走神经活动增强性心律失常 ,可定期随访 。

Objective To investigate the electrocardiogram recording methods and the clinical significance of arrhythmia induced by vagus nerve excitability enhancement. Methods Electrocardiographic changes in 281 children, whose electrocardiograms showed wandering rhythm, junctional rhythm, or first degree and type I second degree atrioventricular block, were analyzed after sitting-horizontal test, exercise test and atropine test. Results There were 176 cases whose electrocardiograms got normal after sitting-horizontal test, 61 cases whose electrocardiograms resumed normal after exercise test, and 30 cases whose electrocardiograms became normal after atropine test. All cases were not treated with antiarrhythmic drugs. Conclusion The study suggested that the electrocardiogram recording methods should be improved in children with common arrhythmia, periodical follow-up surveys should be done for children with vagal arrhythmia, and laboratory examinations along with antiarrhythmic drugs should be used with discretion.