经食道调搏测窦房结恢复时间结合固有心率的临床应用  

Clinical value of trans-esophageal atrial pacing combined with intrinsic heart rate in evaluationm of sinoatrial node function： observation of 50 cases

作　　者：叶智宾 华期禹 金宏庆 

机构地区：[1]广东江门市第三人民医院心内科,广东529000 [2]江西新余市新钢中心医院

出　　处：《中国急救复苏与灾害医学杂志》2016年第6期585-587,共3页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的探讨应用经食道心房调搏早期诊断病态窦房结综合征的价值。方法50例均为2013年1月-2015年12月在本院门诊或住院的窦性心动过缓患者，有症状和无症状窦性，其中单纯窦性心动过缓42例，病态窦房结综合征8例。通过经食道心房调搏测定窦房结恢复时间，用阿托品、心得安后重复心房调搏。结果食道调搏：窦缓组SNRT平均值为（1227±152）ms，SSS组为（1609±108）ms，二组差异无统计学意义（P〉0．05）。这是因为对照组均系窦缓患者，经心率校正后，窦缓组CSNRT为（328±142）ms，SSS组为（661±60）ms，二组相比较有显著差异（P〈0．01）。静脉注射阿托品及心得安后，窦缓组SNRT为（977±141）ms，SSS组SNRT为（1534±226）ms，两组差异有统计学意义（P〈0．01）。说明植物神经系统为SNRT有明显影响。国内报导正常值，SNRT成人高限400ms，老人1500ms，CSNRT成人高限520ms，老人600ms，本文窦缓组的SNRT均〈1400ms，CSNRT〈520ms，皆超逾以上标准。固有心率：窦缓组的IHR为91±15次／分（按年龄IHR正常最低值为79±5次／min），SSS组的IHR为67±4次／min（IHR正常最低值为75±4次份），SSS组的IHR明显低于窦缓组。SSS组均为阳性，窦缓组皆为阴性。IHR与SNRT关系：SSS组的IHR均〈IHR正常最低值，SNRT均〉1400ms，CSNRT均〉520ms，窦缓组SNRT〈1400ms，CSNRT〈520ms的测定值。结论窦房结恢复时间结合固有心率测定能更准确地评价窦房结功能，有利于对病态窦房结综合征的正确诊断。固有心率是另一种反映窦房结功能的有效指标。经食道心房调搏是简便，安全、实用的哦。Objective To investigate the value of trans-esophageal atrial pacing （TEAP） combined with intrinsic heart rate （IHR） in early diagnosis of sick sinus syndrome （SSS）. Methods 50 cases of sinus bradycardia, including symptomatic and asymptomatic sinus, Were enrolled from January 2013 to December 2015 in our hospital outpatient or inpatient, aged（26-60）years, underwent TEAP to measure the sinus node recovery time （SNRT） . Then 20 ml of 25% glucose, with atropine 2 mg＋propranolol 5 mg was injected, by vein 5-10 minutes later the heart rate （（intrinsic heart rate, IHR） was tested. Corrected sinus nodal recovery time （CSNRT） was obtained by SNRT minus the sinus cycle length （SCL）. Results The CSNRT In 42 of the patients was （328± 142） ms, significantly lower than that of the other 8 patients [（661 ±60） ms, P 〈0.01]. These 42 patients were diagnosed as with pure sinus tachicardia, and the other 8 patients were diagnosed as with SSS. The IHR values of the SSS patients were all positive （lower than the normal lowest value）, and the values of IHR of the pure sinus bradycardia patients were all negative. Conclusion A kind of non invasive electrophysiological examination, TEAP is safe, easy to operate, and helpful in early diagnosis of SSS.

关 键 词：食道调搏 窦性心动过缓 窦房结恢复时间 病态窦房结综合征 固有心率 

分 类 号：R541.74[医药卫生—心血管疾病]