直立倾斜试验阳性反应患者心律失常分析  

Study of arrhythmia in patients with positive responses in head-up tilt table test.

作　　者：李雯[1] 王成[1] 谢振武[1] 李茗香[1] 郑慧芬[1] 毛定安[1] 林萍[1] 许毅[1] 

机构地区：[1]中南大学湘雅第二医院儿科心血管病研究室中南大学儿科学研究所,湖南长沙410011

出　　处：《中国实用内科杂志》2007年第2期117-120,共4页Chinese Journal of Practical Internal Medicine

基　　金：国家"十五"科技攻关计划(2004BA720A10);湖南省科技厅资助项目(03SSY4022)

摘　　要：目的探讨直立倾斜试验(HUTT)阳性反应患者心律失常发生的特点。方法对2000年9月至2005年7月在中南大学湘雅第二医院晕厥专科门诊就诊或住院的不明原因晕厥或接近晕厥患者进行HUTT检查(所有患者均签署知情同意书)。分析HUTT过程中心律失常发生情况。采用SPSS10.0统计软件进行统计学处理。结果127例HUTT阳性反应患者中122例(96.06%)患者出现心律失常。107例(84.25%)发生快速性心律失常,并在儿童及舌下含服硝酸甘油倾斜试验(SNHUT)中发生率高(P<0.01),无性别差异(P>0.05)。快速性心律失常以窦性心动过速(98.13%,105/107)多见,其中99例(94.29%)患者在心率达最快后5min内,平均(1.73±1.72)min发生阳性反应。58例(45.67%)患者发生缓慢性心律失常,窦性心动过缓多见(91.38%,53/58),常合并交界性逸搏心律、交界性逸搏和窦性停搏。10例窦性停搏患者平均停搏时间为(12.68±17.94)s。缓慢性心律失常患者基础心率偏慢,且在成人及基础直立倾斜试验(BHUT)过程中发生率高(P<0.05或P<0.01),而男女性别差异无显著性(P>0.05)。结论(1)HUTT过程中心率突然明显增快时应警惕阳性反应的发生。(2)缓慢性心律失常在成人及BHUT中发生率较高,常见类型有窦性心动过缓、窦性停搏、交界性逸搏心律、交界性逸搏等,发生缓慢性心律失常患者的基础心率偏慢。Objective To study the characteristics of arrhythmia in patients with positive responses in head-up tilt table test（HUTT）. Methods Data of 127 patients who had positive responses in HUTI＂ were analysed. SPSS 10. 0 software was used for the statistic analysis of these data. Results A total of 122 （96. 06% ）patients had arrhythmic events. Tachyarrhythmias were found in 107 （84. 25% ）patients and more common in children and in sublingual nitroglycerin-provocated head-up tilt table test （SNHUT）. There was no difference in gender. Sinoatrial tachycardia was common （105/107）. Ninety-nine patients had positive responses within 5 min averaged（ 1.73 ± 1.72）min after their heart rates reached maximum. Bradyarrhythmias were noted in 58 patients（45.67% ）and more common in adults and in baseline head-up tilt table test（BHUT）. Sinoatrial bradycardia was familiar（53/58 ）and often accompanied by junctional escape rhythm,junctional escape and asystole. The averaged time of asystole in 10 cases was （12. 68±17. 94）s. Basic heart rates were slower in patients with bradyarrhythmias. Conclusion （ 1 ） Positive response should be suspected when patient＇s heart rate increases distinctly. （2）Bradyarrhythmias are more often seen in adults and in BHUT. Sinoatrial bradycardia, junctional escape rhythm,junctional escape and asystolc are common types. Basic heart rates are slower in patients with bradyarrhythmias.

关 键 词：心律失常 直立倾斜试验 晕厥 

分 类 号：R5[医药卫生—内科学]