摘要
背景慢性心力衰竭(CHF)患者24 h动态心电图(ECG)的心脏节律变化是否具有特征目前仍无明确定论。使用常规12导联长时程心电系统监测CHF患者心律失常特征时,部分患者常难以耐受,依从性较差。目的研究单导长时程ECG在CHF患者心脏节律特点分析中的应用价值。方法回顾性选取湖北省天门市第一人民医院2016年1月—2018年10月收治的行单导联长时程(24 h)ECG检查的CHF患者82例为研究对象。根据心律失常发生频率将患者分为罕发组(心律失常占心搏总数的比例<0.1%,26例)、偶发组(心律失常占心搏总数的比例为0.1%~1.0%,34例)及频发组(心律失常占心搏总数的比例>1.0%,22例)。比较三组一般资料,观察三组心律失常发生情况及心脏节律特点。结果罕发组均出现房性心律失常,其中成对房性期前收缩18例、短阵房性心动过速10例;出现室性期前收缩22例,其中发生次数≤5次18例、>5次4例;出现二度Ⅱ型窦房传导阻滞1例。罕发组单导联长时程心电Lorenz-RR散点图整体呈主导节律周围稀疏散点分布。偶发组均出现房性心律失常,其中阵发性房性心动过速20例、房性并行心律16例、房性期前收缩未下传8例;出现室性期前收缩20例,其中多源性室性期前收缩10例、室性并行心律8例、单源性室性期前收缩2例。偶发组单导联长时程心电Lorenz-RR散点图整体呈主导节律外有较多散点分布,分布较广者更稀疏,分布较窄者更密集。频发组出现房性心律失常18例,其中阵发性房性心动过速16例、房性并行心律12例、房性期前收缩未下传10例;出现室性期前收缩10例,其中单源性室性期前收缩4例、多源性室性期前收缩4例、室性并行心律2例。频发组单导联长时程心电Lorenz-RR散点图整体呈多分布或团块状分布。结论单导联长时程心电Lorenz-RR散点图能够反映CHF患者心脏节律特点,从而指导临床对CHF患者心脏节律的控制与治疗;同时单导联长时程ECG检查操作简便,通过与大数据散点图分析结合能更直观地反映CHF患者的心脏节律特点,方便临床调整后续治疗方案。
Background There is still no clear conclusion on the characteristics of cardiac rhythm changes of 24-hour ambulatory electrocardiogram(ECG)in patients with chronic heart failure(CHF).When using conventional 12-lead long-term ECG system to monitor the characteristics of arrhythmia in patients with CHF,some patients are often difficult to tolerate and have low compliance.Objective To study the application value of single-lead long-term ECG in the analysis of cardiac rhythm characteristics in patients with CHF.Methods Eighty-two patients with CHF who underwent long-term singlelead 24-h ECG examination were retrospectively selected from January 2016 to October 2018 in the First People's Hospital of Tianmen in Hubei Province.According to the frequency of arrhythmia,patients were divided into three groups:rare group(the proportion of arrhythmia in the total number of heartbeats was<0.1%,26 cases),occasional group(the proportion of arrhythmia in the total number of heartbeats was 0.1%-1.0%,34 cases)and frequent group(the proportion of arrhythmia in the total number of heartbeats was>1.0%,22 cases).The general data of the three groups were compared,and the occurrence of arrhythmia and the characteristics of cardiac rhythm in the three groups were observed.Results In the rare group,all patients had atrial arrhythmia,including 18 cases of paired atrial extrasystole and 10 cases of paroxysmal atrial tachycardia;22 patients had ventricular extrasystole,of which the number of occurrences was less than or equal to 5 times in 18 cases and>5 times in 4 cases;1 patient had second degree typeⅡsinoatrial block.In the rare group,the single-lead long-term Lorenz-RR scatter map showed sparse scatter distribution around the dominant rhythm as a whole.In the occasional group,all patients had atrial arrhythmia,including 20 cases of paroxysmal atrial tachycardia,16 case of atrial parallel rhythm,8 cases of atrial premature beats not transmitted down;20 patients had ventricular extrasystole,including 10 cases of multiple ventricular extrasystole,8 cases of ventricular parasystole,2 cases of single ventricular extrasystole.In the occasional group,the single-lead long-term Lorenz-RR scatter map showed that there were more scattered spots outside the dominant rhythm,the wider distribution was more sparse,and the narrower distribution was denser.In the frequent group,18 patients had atrial arrhythmias,including 16 cases of paroxysmal atrial tachycardia,12 cases of atrial parallel rhythm,10 cases of atrial premature beats not transmitted down;10 patients had ventricular extrasystole,including 4 cases of single ventricular extrasystole,4 cases of multiple ventricular extrasystole,2 cases of ventricular parasystole.In the frequent group,the single-lead long-term Lorenz-RR scatter map showed multi-distribution or mass distribution as a whole.Conclusion Single-lead long-term Lorenz-RR scatter map can reflect the characteristics of cardiac rhythm in patients with CHF,thus guiding clinical control and treatment of cardiac rhythm in patients with CHF.At the same time,single-lead long-term ECG examination is easy to operate,and combined with big data scatter map analysis can more directly reflect the characteristics of cardiac rhythm in CHF patients and facilitate clinical adjustment of follow-up treatment plans.
作者
夏旭辉
尹琼
刘曼华
唐敏
XIA Xuhui;YIN Qiong;LIU Manhua;TANG Min(Department of Cardiovascular Internal Medicine,the First People's Hospital of Tianmen in Hubei Province,Tianmen 431700,China;Department of Ultrasonography,the First People's Hospital of Tianmen in Hubei Province,Tianmen 431700,China)
出处
《实用心脑肺血管病杂志》
2020年第12期100-103,108,共5页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词
心力衰竭
心电描记术
心脏节律
散点图
Heart failure
Electrocardiography
Heart rhythm
Scatter plot
