动态心电图对高血压患者伴心房颤动发生机制的研究  

Study on the mechanism of atrial fibrillation in hypertension patients by ambulatory electrocardiography

作　　者：顾婷婷[1] Gu Ting-ting(Health Management Center,the Second Affiliated Hospital of Nanjing Medical University,Nanjing Jiangsu 210011,China)

机构地区：[1]南京医科大学第二附属医院健康管理中心,江苏南京210011

出　　处：《实用心电学杂志》2018年第5期340-342,共3页Journal of Practical Electrocardiology

基　　金：江苏省高校自然科学研究基金资助项目(13KJB320005)

摘　　要：目的分析高血压患者发生心房颤动(房颤)的动态心电图特征、结构原因及电生理机制。方法选择120例高血压住院患者进行动态心电图及彩色多普勒超声心动图检查,根据房颤发作情况分成A、B、C三组:A组不伴有房颤(36例),B组伴阵发性房颤(39例),C组伴持续性或永久性房颤(45例)。对三组的左心房内径(LAD)、左室舒张末期内径(LVD)、左室收缩末期内径(LVS)、室间隔厚度(IVST)和左室射血分数(LVEF)等指标进行分析。结果C组的LAD、LVD、LVS、IVST和LVEF这5个指标与A、B两组比较,差异有统计学意义(P<0.01);B组上述5个指标均大于A组,但仅LAD差异有统计学意义(P<0.01)。B组中触发性房性早搏与非触发性房性早搏患者的联律间期比较,差异有统计学意义(P<0.01)。结论高血压患者发生心房颤动的机制主要是左心房结构改变,其主要触发因素为房性早搏。Objective To analyze the characteristics of ambulatory electrocardiography（AECG） of hypertension patients with atrial fibrillation（AF）, and the structural causes and electrophysiological mechanism of complicated AF. Methods A total of 120 hospitalized hypertension patients underwent AECG and color Doppler echocardiography examinations. According to the occurrence of AF, they were divided into three groups： group A（without AF, 36 cases）, group B（with paroxysmal AF, 39 cases） and group C（with persistent or permanent AF, 45 cases）. The indexes including left atrial diameter（LAD）, left ventricular end-diastolic diameter（LVD）, left ventricular end-systolic diameter（LVS）, inter-ventricular septal thickness（IVST） and left ventricular ejection fraction（LVEF） were analyzed among the three groups. Results Compared with group A or B, the five indexes of LAD, LVD, LVS, IVST and LVEF of group C varied significantly（ P 〈0.01）; the above five indexes of group B were all higher than those of group A, but only LAD varied with statistically significant difference（ P 〈0.01）. In group B, the coupling interval varied significantly between the patients with triggered and non-triggered atrial premature beats（ P 〈0.01）. Conclusion The mechanism of complicated AF in hypertension patients is mainly structural changes of left atrium and the dominant triggering factor is atrial premature beats.

关 键 词：心房颤动 高血压 动态心电图 彩色多普勒超声心动图 房性早搏 联律间期 

分 类 号：R540.4[医药卫生—心血管疾病]