摘要
目的探讨风湿性心脏瓣膜病(风心病)持续心房纤颤(房颤)伴长RR间歇(RR间期≥1.5s)患者的临床特点及永久心脏起搏器治疗的指征。方法对我院2003年1月至2006年1月收住院的94例风心病持续房颤患者的临床资料进行回顾性分析。结果①94例患者长RR间歇组37例(39.4%),无长间歇组57例(60.6%)。②临床症状:无症状7例(7.4%),劳力性呼吸困难(包括活动后气短、喘憋)45例(47.9%),心悸23例(24.5%),胸闷17例(18.1%),头晕1例(1.1%),晕厥1例(1.1%)。③长RR间歇组年龄(P<0.01)、风心病程(P<0.05)、房颤持续时间(P<0.01)均较无长RR间歇组高,左室收缩末内径减小(P<0.05)。最长RR间期与最小心室率(P<0.01)、平均心室率(P<0.01)和长RR间歇发生频数(P<0.01)相关。④长RR间歇组β受体阻滞剂和两种以上负性传导药物联合使用率以及高血压伴发率均较无长间歇组高,而瓣膜手术率低,永久心脏起搏器治疗12例。结论头晕、晕厥是风心病持续房颤伴长RR间歇患者相对特异的临床症状。年龄大、病程长、左室收缩末内径减小、伴发高血压及使用β受体阻滞剂或两种以上负性心率药物的风心病房颤患者,需警惕合并长RR间歇。清醒状态下RR间期>3.0s、有相关临床症状或同时应用多种负性心率药物的患者,需考虑永久心脏起搏器治疗。
Objective To analyze the clinical manifestations of atrial fibrillation （AF） with long RR intervals （LRR） associated with rheumatic heart disease（RHD） and the indications of implantation permanent cardiac pacemaker. Methods The clinical data of 97 patients with atrial fibrillation associated with rheumatic heart disease （RHD） hospitalized in our hospital during 2003.1-2006.1 were analyzed retrospectively. Results （1）94 patients were investigated in the study, 37（39.4%）with LRR and 57 cases （60.6%） without LRR. （2）Patients were either asymptomatic, or had dyspnea associated with exercise, palpitation, chest distress, dizziness and syncope. （3）There were significantly difference in age（P〈0.01 ）, duration of RHD （P〈0.05）and AF（P〈0.01 ）, and left ventricular end-systolic diameter （LVESD） （P〈 0.05） between the LRR and NLRR groups. The length of RR interval was correlated with the minmum heart rate（HR） （P〈0.01）, mean HR（P〈0.01 ） and frequency of long RR intervals within 24 hours （P〈0.01）. （4）Treatment of β-receptor blocker （BRB） or more than 2 kinds of medicines for reducing ventricular rate and accompany with hypertension were more frenquently seen in LRR group than controls, while patients with LRR had less valvular operations. 12 patients were implanted permanent cardiac pacemakers. Conclusion Diziness and syncope are relatively specific symptoms for patients with LRR.There are some indications to LRR in the patients with AF associated with RHD such as aging,long duration of RHD and AF,decrease of LVESD,accompany with hypertension, use of BRB or combined use of more than 2 kinds of rate-control drugs, and without valvular operations. Patients with RR intervals longer than 3.0 s during consciousness, or with obvious symptoms which need more than 2 kinds of rate-control drugs may be advised to implant permanent cardiac pacemakers.
出处
《中国心血管病研究》
CAS
2007年第5期321-324,共4页
Chinese Journal of Cardiovascular Research
关键词
心脏瓣膜疾病
心房颤动
长RR间歇
心脏起搏
人工
Heart valve diseases
Atrial fibrillation
Long RR intervals
Pacemaker, artificial
