论文部分内容阅读
目的探讨食道电生理检查在窦性心动过缓(SB)中的临床应用价值。方法回顾分析纳入342例经体检及门诊诊断为SB的患者,依据心率<50bpm(68例,占19.8%)及≥50bpm(274例,占80.0%)而分为二组,并按性别、不同年龄段、有无症状分组,所有患者均行十二导心电图(ECG)、动态心电图检查(DCG)、药物前后食道电生理检查。结果 342例患者中检出窦房结功能障碍者58例,占16.9%,275例为迷走神经张力过高导致的窦性心动过缓,占80%,窦房结伴房室结功能低下者9例,占0.02%。心率<50bpm及≥50bpm在窦房传导时间(SACT)无差异,而在窦房结恢复时间(SNRT)、校正窦房结恢复时间(CSNRT)有统计学差异(p<0.05),心率<50bpm组迷走神经张力明显高于无症状组。随年龄增长,SACT、SNRT、CSNRT值越大,迷走神经张力渐低,差异有统计学意义。有症状组其SNRT、CSNRT明显延长,差异有统计学意义。结论SB中年龄越大,窦房结功能障碍的发生率越高,年龄越轻,则迷走神经张力增高仍然是SB的主要原因。单纯SB的程度对于诊断窦房结功能障碍无明显临床价值,需结合患者年龄,通过食道电生理检查评价,此检查安全、无创、操作简便,具有独特而重要的临床价值,适宜临床推广应用。
Objective To investigate the clinical value of esophageal electrophysiological examination in sinus bradycardia (SB). Methods Retrospective analysis of 342 patients diagnosed as SB by physical examination and outpatient diagnosis. The patients were divided into two groups according to heart rate <50bpm (68 cases, 19.8%) and ≥50bpm (274 cases, 80.0%), Age group, asymptomatic group, all patients underwent 12-lead electrocardiogram (ECG), ambulatory electrocardiogram (DCG), medication before and after esophageal electrophysiological examination. Results Among 342 patients, 58 cases (16.9%) had sinus node dysfunction, 275 cases had sinus bradycardia (80%) caused by vagal hyper tension, and 9 cases had sinus node atrioventricular node dysfunction , Accounting for 0.02%. Heart rate <50bpm and ≥50bpm had no difference in SACT, but there was a significant difference (p <0.05) in SNRT and CSNRT (p <0.05), heart rate <50bpm Group vagal tone was significantly higher than asymptomatic group. With age, the greater the SACT, SNRT, CSNRT values, vagal tone decreased, the difference was statistically significant. Symptomatic group of its SNRT, CSNRT significantly prolonged, the difference was statistically significant. Conclusion The older SB, the higher the incidence of sinus node dysfunction, the younger, the vagus nerve tension is still the main reason for SB. The level of simple SB has no obvious clinical value for the diagnosis of sinus node dysfunction. It needs to be combined with the age of the patient and evaluated by esophageal electrophysiological examination. The examination is safe, non-invasive and easy to operate. It has unique and important clinical value and is suitable for clinical popularization and application.