摘要
目的 探讨血管迷走性晕厥（VVS）儿童卧、立位QT间期离散度（QTd）及P波离散度（Pd）的变化。方法 直立倾斜试验（HUTT）阳性的VVS患儿46例为研究组。年龄7～17岁，平均（11．91±2．09）岁。用SR-1000A心电综合自动分析仪描记卧位及立位12导联同步体表心电图（12ECG）。匹配健康儿童30例为对照组。选择窦性心律波形清晰的12ECG3个心动周期，测量心率（HR）、QTd与Pd，按Bazete公式校正心率后得出QTcmax、QTcmin、QTcd、Pcmax、Pcmin、Pcd。结果 1．对照组卧位较立位最大QT间期（QTmax）、最小QT间期（QTmin）、最大P波时间（Pmax）均明显延长（Pα〈0．01），最小P波时间（Pmin）缩短（P〈0．05），Pd延长（P〈0．05），QTd、QTcmax、QTcmin、QTcd、Pcmax、Pcmin、Pcd未见明显变化（Pα〉0．05）。2．研究组卧位较立位QTmax、QTmin、QTd、QTcd、Pmax、Pd、Pcd明显延长（Pα〈0．01），Pcmax延长（P〈0．05），Pcmin明显缩短（P〈0．01），QTcmax、QTcmin、Pmin未见明显变化（Pα〉0．05）。3．研究组较对照组卧位QTmax、QTcmax、Pcd延长（Pα〈0．05），QTd、QTcd、Pmax、Pcmax延长（Pα〈0．01）；立位Pcd延长（Pα〈0．05），Pmax、Pcmax延长（Pα〈0．01）。4．研究组较对照组卧位时HR稍降低（P〉0．05），立位时HR明显增加（P〈0．01），HR增加在研究组与对照组比较未见差异（分别增加15．29次／min vs 12．57次／min，P〉0．05）。5．VVS患儿在血管抑制型和混合型时卧、立位的QTd及Pd未见差异（Pα〉0．05）。6．VVS患儿在卧位、立位时QTd及Pd不存在男女性别差异（Pα〉0．05）。结论 VVS患儿卧位时更易发生心律失常；当体位改变时QTd、Pd明显受自主神经功能影响，表明该法对心脏自主神经功能的评价具有指导价值。
Objective To probe the variation of QT interval dispersion（QTd） and P - wave dispersion（Pd） in supine and erect position for children with vasovagal syncope（VVS）. Methods Twelve - lead simultaneous body surface electrocardiogram（ 12 ECG） in supine and erect position were taken of 46 cases which were positive in head - up tilt test（HUTY） with VVS（ research group） aged from 7 to 17 [ mean （ 11.91±2.09） ] years old and 30 healthy children as control group with SR - 1000A automated electrocardiography. The heart rate（ HR）, QTd and Pd were tested by hand during 3 clear waves cycles in 12 ECG,and QTcmax,QTcmin,QTcd,Pcmax,Pcmin,Ped were detected after correcting H R acording to Bazett formula. Results 1. QTmax, QTmin, Pmax significantly prolonged （Pα〈 0.01 ） , Pmin shortened （P 〈 0.05 ） and Pd prolonged （ P 〈 0.05 ） in control group in supine position compared with the erect position. 2. QTmax, QTmin, QTd, QTcd, Pmax, Pd, Pcd significantly prolonged（ Pα 〈 0.01 ） , Pcmax slightly prolonged （ P 〈 0.05 ） and Pcmin significantly shortened （ P 〈 0.01 ） in research group in supine position compared with the erect position. 3. QTmax,QTcmax,Pcd increased（Pα〈0.05） and QTd,QTed,Pmax,Pcmax prolonged （Pα〈 0.01 ） in research group in supine position compared with control group, Pcd（ P 〈 0.05 ）, Pmax, Pcmax prolonged（ Pα〈 0.01 ） in research group in erect position. 4. HR slightly reduced （ P 〉 0.05 ） in supine position and significantly increased （ P 〈 0.01 ） in erect position in research group compared with control group. There were no differences in HR increase in both research group and control （ 15.29 times per min vs 12.57 times per min ,P 〉 0.05, respectively）. 5. There were no differences in QTd and Pd in supine and erect position in beth sex and the result of HUTT children with VVS（ Pα〉 0.05）. There were no differences in QTd and Pd in supine and erect position in different gender with VVS children（ Pα〉 0.05 ）. Conclusions QTd, QTcd, Pd, Ped obviously prolonged in supine position compared with those in erect position for VVS children,which indicated that VVS children were more vulnerable to arrhythmic in supine position;QTd and Pd influenced by autonomic nervous system function with the change of the body posture influences by autonomic nervous system function manifested that this method has directive value for the evaluation of autonomic nervous system function.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2007年第1期16-18,共3页
Journal of Applied Clinical Pediatrics
基金
"十五"国家科技攻关计划项目资助(2004BA720A10)
湖南省科技厅项目资助(03SSY4022)
