中西医结合治疗病态窦房结综合征60例

<正>病态窦房结综合征(SSS)是一种较为常见的,主要由窦房结自身及其周围组织病变导致窦房结冲动传导紊乱所致心律失常综合征。我院于2002年1月～2009年12月对60例SSS患者采用中西医结合治疗,取得较为满意效果。现报告如下:     

病态窦房结综合征药物治疗现状

病态窦房结综合征(SSS)的药物治疗对无条件安装起搏器者仍有一定意义,对初发者亦可先试用,故结合文献简介如下: (一)氨茶硷 国外Beuditt用氨茶硷治疗10例有反复发作晕厥伴窦性停搏、房室阻滞的缓慢性心律失常的青年人收到良好效果。1986～1990年贾锦霞等首先在国内采用氨茶硷治疗30例SSS,用药方法:氨茶硷250mg+5％葡萄糖500ml静滴,每日1次,睡前加服氨茶硷缓释片0.2g,15～30日后,改口服0.1g,一日三次,     

中西医结合治疗病态窦房结综合征46例疗效分析

近年来我们应用中西医结合的方法治疗病窦46例，疗效满意，报道如下。     

病态窦房结综合征的当今概念

SSS由Lown于1967年命名。一般是指由器质性病变引起的窦房结功能障碍。本文简述近年来关于SSS病因,诊断和治疗等方面研究的进展。     

美心力治疗病态窦房结综合征疗效观察

美心力为注射用环磷腺苷(cAMP Pro Injection),是一种新型非强心甙类强心药物,其治疗充血性心力衰竭总有效率达80.4%,疗效满意.自1997年以来,我们应用cAMP治疗病态窦房结综合征(Sick Sinus Syndroms,SSS)27例,同样取得满意疗效,现报告如下.     

病态窦房结综合征的诊治误区

病态窦房结综合征（简称SSS）是以是窦性心律失常为基础（如窦性心动过缓、窦性停搏、窦房传导阻滞等）而产生头晕、晕厥等症状群组成的综合征,同时可表现出多种快速心律失常（如心房颤动、心房扑动、房性心动过速等,所谓慢一快综合征,某些SSS患常以快速心律失常就诊,易引起误诊误治。     

温阳益气法治疗病态窦房结综合征

<正>病态窦房结综合征是窦房结的起搏和冲动传出发生障碍而引起一系列临床表现和心电图变化的总称,以心动过缓为主,也可发生异位性心动过速,目前尚无有效的治疗方法。     

洋金花和极化液联用治疗冠心病所致病态窦房结综合征临床研究

目的:探讨联合应用洋金花和葡萄糖-胰岛素-钾(GIK)极化液治疗病态窦房结综合征(SSS)的疗效.方法:100例SSS患者随机分为两组,治疗组68例,洋金花散剂0.3 g,口服,每日1次,10%葡萄糖500ml+胰岛素8u+10%氯化钾10 mL静脉滴注,每日1次,共计14 d;对照组32例仅行上述极化液静脉滴注治疗.于治疗前和治疗后分别行24 h动态心电图及食管电生理检查.结果:治疗后,治疗组平均心率、24 h总心率和对照组相比差异有显著性(P＜0.01);窦房结恢复时间(SNRT)、校正后窦房结恢复时间(cSNRT)和窦房传导时间(SACT)和对照组相比有显著性差异(P＜0.01).结论:联合应用洋金花和CIK极化液治疗病态窦房结综合征是一种安全有效的方法.     

病态窦房结综合征的早期诊断与治疗探讨

我院近14年来收治病态窦房结综合征(SSS)共93例,其中60岁以上占大多数(45例,48.4%)。病因以冠心病居首位(70例,75.3%)。提示窦性心动过缓是SSS 最早最常见的表现。本文对SSS 的早期诊断与治疗进行了讨论。     

Pacing for Carotid Sinus Syndrome and Sick Sinus Syndrome

BRIGNOLE, M., ET AL: Pacing for Carotid Sinus Syndrome and Sick Sinus Syndrome. The real incidence of pacemaker implants for carotid sinus syndrome (CSS) and the relation between CSS and sick sinus syndrome (SSS) is not precisely known. Patients who needed pacing therapy because of atrial bradyarrhythmias were investigated by means of carotid sinus massage, dynamic ECG, and invasive electrophysiological sinus node evaluation. Of 298 consecutive patients receiving a pacemaker implant, 36 (12%) had a severe cardioinhibitory carotid sinus reflex with reproducible spontaneous symptoms (CSS), 33 (11%) had sinus bradycardia < 50 beat/min or an abnormal electrophysiological evaluation (SSS) and 24 (8%) had both (CSS + SSS). The annual incidence was 40, 37, and 26, respectively, implants per year/million of inhabitants (total incidence 325). Patients affected by CSS, if compared with those affected by SSS, showed: a higher prevalence of syncope (97% vs 42%); more syncopal, episodes per patient (2.9 ± 2 vs 1.8 ± 0.9); a lower prevalence of associated cardiac diseases (53% vs 100%); cardiac enlargement (36% vs 88%); heart failure (6% vs 36%) and paroxysmal atrial fibrillation (0% vs 42%); and a more frequent indication for VVI pacing (75% vs 3%). In patients with CSS + SSS, intermediate characteristics were present. In conclusion, CSS is as frequent an indication to cardiac pacing as SSS; clinical differences justify a distinction between them, even if they are associated in 26% of cases.     

心室起搏管理对病态窦房结综合征患者心功能的影响

目的：观察心室起搏管理（managed ventricular pacing,MVP）对病态窦房结综合征（sick sinus syndrome,SSS）患者心功能的影响.方法：42例植入具有MVP功能的双腔起搏器（Medtronic Adapta ADD01/ADDR01/ADDRL1）的SSS患者,先以双腔起搏（DDD/R）模式工作6个月,再程控为MVP模式工作6个月,统计两种模式下右心室起搏比例,并比较两种模式下患者心功能的变化.结果：在DDD/R模式下,平均右心室心尖部起搏比例达43.6％,左心室射血分数（left ventricular ejection fraction,LVEF）从（56.5±2.6）％下降至（54.1±3.0）％（P=0.001）,左心室舒张末期直径（left ventricular end-diastolic diameter,LVEDD）从（49.6±2.6）mm升高至（51.4±2.4）mm（P=0.002）,B型利钠肽（B-type natriuretic peptide,BNP）从（77.0±16.2） pg/mL升高至（87.2±16.4） pg/mL（P=0.032）.在MVP模式下,平均右心室心尖部起搏比例仅为1.8％,LVEF从（54.1±3.0）％上升至（55.4±1.4）％（P=0.042）,LVEDD从（51.4±2.4）mm下降至（50.2±2.0）mm（P=0.016）,BNP从（87.2±16.4） pg/mL下降至（86.5±14.9） pg/mL（P=0.852）.另外,DDD/R模式下有4例患者发生阵发性心房颤动,而MVP模式下仅1例发生阵发性心房颤动,但差异无统计学意义（P=0.180）.结论：与DDD/R模式比较,MVP模式能显著减少右心室起搏比例,且对心功能有较好的保护作用.     

Cough Syncope Caused by Sinus Arrest in a Patient with Sick Sinus Syndrome

Cough syncope is a syndrome in which dizziness or syncope occurs after prolonged bouts of cough. This paper presents a case of 63-year-old man with recurrent dizziness and syncope. The 24-hour ambulatory electrocardiogram and intracardiac electrogram showed sinus node dysfunction with sinus arrest, both spontaneous and inducible by voluntary cough. Sinus arrest was sometimes associated with dizziness. A permanent VVI pacemaker was implanted and no further cough syncope has occurred. We suggest that sinus arrest may play a role as a mechanism of cough syncope in a patient with sick sinus syndrome.     

环磷腺苷葡胺合心宝丸治疗病态窦房结综合征40例疗效观察

目的:观察环磷腺苷葡胺联合心宝丸治疗病窦的疗效。方法:将82例病窦患者随机分为两组,治疗组40例予静滴环磷腺苷葡胺同时口服心宝丸,对照组42例予静滴异丙肾上腺素和阿托品。结果:经15d治疗后治疗组临床症状改善及心率变化指标优于对照组,两组比较差异有统计学意义(P<0.05)。结论:环磷腺苷葡胺联合心宝丸治疗病窦综合征疗效显著,值得临床推广。     

Antibodies to Human Sinus Node in Sick Sinus Syndrome

The incidence of autoantibodies against human conducting tissue was studied in 45 pacemaker patients with sick sinus syndrome (SSS), in 17 patients with bradyarrhythmia, and jive patients with hypertensitive carotid sinus syndrome. Antibodies against the human sinus node were demonstrated in 29% of patients with SSS and in 24% of patients with bradyarrhythmia; a tenfold risk of SSS could be calculated in patients with this antibody as compared to age-matched controls. At least two subtypes of anti-sinus node antibodies were demonstrated: an antibody absorbable and another one not absorbable with ventricular myocardium. Patients with SSS and prior myocarditis of rheumatic fever have a threefold incidence of that antibody, demonstrating that anti-conducting tissue antibodies are etiologic indicators for former inflammatory heart disease. These antibodies may play a role in the secondary immunopathogenesis of sick sinus syndrome. This hypothesis emerges as an interesting new pathogenetic concept.     

The Natural History of Sick Sinus Syndrome

A literature review has addressed the two major factors in disease progression in sick sinus syndrome: atrioventricular block and atrial fibrillation. An incidence of atrioventricular block of 8.4 percent in a follow-up period of 34.2 months is considered clinically significant and sufficient to justify use of a ventricular lead in pacemaker management. Atrial fibrillation occurs much more commonly [22.3%] in ventricular pacing than with atrial demand pacing (3.9%) in a 21/2 year observation period. Coincident with the reduction in arrhythmia achieved by atrial demand pacing is a significant reduction in systemic embolism (1.6% vs. 13%]. This is considered largely to be due to the improved rhythm control with AAI pacing but also possibly to the avoidance of retrograde atrioventricular conduction. The benefits of AAI pacing in terms of mortality in sick sinus syndrome have not yet been fully assessed. In the future, DDI pacing is recommended with, in some patients, the addition of another sensor to provide rate responsiveness on exercise.     

Atrioventricular Conduction in Sick Sinus Syndrome

With the increasing recognition of the pacemaker syndrome and with the availability of newer methods of pacing therapy, the status of the atrioventricular (AV) conduction in patients with Sick Sinus Sydrome (SSS) becomes crucial in the choice of mode of pacing. At the Philippine Heart Center, from April 1983 to November 1986, the sinus and AV node function studies of 46 patients who, by electrophysiological studies had sinus node dysfunction (SND)-SN recovery time (SNRT) >1400 msec, were reviewed. These were arbitrarily classified according to duration of SNRT into: Group A—borderline SND, SNRT from 1,401 to 1,499 msec (n = 4); Group B—mild SND, SNRT from 1,500 to 2,499 msec fn = 25); Group G—moderate SND, SNRT from 2,500 to 3499 msec fn = 6); Group D— severe SND, SNRT of 3,500 m and above (n = 11). Out of the 46, 14 (30%) had concomittant AVN dysfunction (AVND)—antegrade block rate < 130 beats per minute (BPM). The percentage occurrence of AVND was noted as follows: Group A—25% (1/4); Group B—28% (7/25); Group G—50% (3/6); Group D—27% (3/11). Out of the 14 patients with concomittant AVND, 5(35%) had antegrade block rate < 100 BPM, 3 in Group R and 2 in Group D. The study shows that AVND occurs in only 30% of SSS patients. Its occurrence and severity has no bearing on the degree of SND. In these, antegrade block was at a rate higher than 100 BPM in the majority of patients. The data suggest that most of SSS patients may benefit from atrial demand pacemaker which therapeutically is of more advantage over the ventricular demand type inasmuch as AV synchrony is retained, thus pacemaker syndrome is prevented.     

Termination of Symptoms in the Sick Sinus Syndrome by Atrial Fibrillation

A female patient with symptomatic sick sinus syndrome (SSS) had a permanent pacemaker implanted. She later developed chronic atrial fibrillation with an adequate ventricular rate. When the pulse generator failed she was found to be clinically asymptomatic. This patient had never adjusted emotionally to her pacemaker and, since she was asymptomatic and in a stable rhythm, the failed pacemaker was not replaced. Possibly, thought should be given to the discontinuance of pacing for the SSS when, in the presence of adequate A-V conduction, stable atrial fibrillation develops.     

刺五加注射剂治疗病窦综合征24例临床研究

病态窦房结综合征是临床较常见的危重症,不少病人需安置起搏器以维持生命,但昂贵的费用及有创的安置术使大量的患者望而却步。我们采用中西医结合的方法,用“刺五加注射剂”静滴治疗本综合征,并与传统西药“阿托品”进行对照研究,其即刻有效率达８８３３％,短期有效率为８０７５％,均明显高于对照组,统计学上有明显差异（Ｐ＜００１）。研究表明,用“刺五加注射剂”治疗本病,确能使大部分病人临床症状改善,心率上升,ＳＮＲＴ和ＣＳＮＲＴ缩短,其疗效明显优于阿托品,且无任何毒副作用。刺五加在国内药源丰富,价格便宜,是目前治疗本病的一种较好的、较有希望的药物。