摘要
目的：探讨食管心电生理及２４小时动态心电图评估植物神经致窦房结和房室结功能不全及其预后。方法：用食管心电生理检测阿托品用药前后各生理参数，对比２４小时动态心电图监测及远期随访。结果：５８例病态窦房结综合征患者依据心电生理及２４小时动态心电图表现分为３型：Ｉ型为窦房结功能抑制型；Ｉ型为房室传导功能减退型；ＩＩ型为双结病变型。ＩＩ型黑或晕厥发生率（７５％）明显高于其它类型。有症状者２４小时动态心电图平均间歇时间２．４２±０．２４秒，显著长于无症状者１．６８±０．１６秒（Ｐ＜０．０１），与窦房结恢复时间存在明显正相关（ｒ＝０．４２，Ｐ＜０．０５）。经４．２±１．２年远期随访，其中６例因病情需要安装永久型起搏器，其后生活质量明显改善，无一例发生持续严重房室传导阻滞。结论：迷走神经是影响窦房结、房室结功能的重要外源性因素，食管心电生理与２４小时动态心电图对病态窦房结综合征的评估具有重要临床价值；起搏治疗可明显改善病态窦房结综合征患者的生活质量，对远期预后影响不大；房室传导阻滞远期发生率小。
Objective:To investigate the clinical significance and prognosis of sinoatrial node(SAN)and atrioventricular node(AVN)dysfunction caused by the parasympathetic nerve system. Methods:Electrophysiological parameters of the patients were determined by esophageal cardiac electrophysiological testing and 24 h ambulatory electrocardiogram(ECG)before and after the administration of atropine. Results:Fifty eight patients diagnosed as sick sinus syndrome(SSS)caused by parasympathetic nerve dysfunction,of which three types were classified according to their electrophysiological parameters of ECG.Type I( n =24):inhibition of SAN;type II( n =22):delay of atrioventricular node transmission;type III( n =12):dysfunction of both SAN and AVN.In type III,the attack rate of amaurosis and syncope was 75%,much higher than in the other types( p <0 05).In the symptomatic patients,the average intermission of ambulatory ECG was 2.42±0.24 s which was obviously longer than that of the non symptomatic ones(1 68±0.16 s, p <0 01),positive correlation was found between the intermission time and sinus node recovery time( r=0.42,p<0 05).In the 6 patients implanted permanent pacemakers among a follow up of 4.2±1.2 years of the 58 patients,no persistent severe AVB occurred. Conclusion:Parasympathetic nerve activity is very important for the function of SAN and AVN.Esophageal cardiac electrophysiology and ambulatory ECG have great clinical significance in evaluating the SSS patients.The implantation of pacemaker can obviously improve the life quality of patients but has no great influence on long term prognosis.The attack rate of AVB is very rare.
出处
《中国循环杂志》
CSCD
1996年第11期671-673,共3页
Chinese Circulation Journal
关键词
食管心电生理
动态心电图
预后
病窦综合征
Esophageal cardiac electrophysiology
24 h Ambulatory electrocardiogram
Sick sinus syndrome (Chinese Circulation Journal
1996
11:671.)
