期前收缩后心肌复极异常80例临床分析

目的探讨期前收缩后心肌复极异常的临床意义。方法分析250例期前收缩后心肌复极的变化情况。结果期前收缩伴心肌复极异常组和无复极异常组，心血管疾病分别为70／80例与58／170例，其中冠心病分别39／80例与18／170例，差异有显著性意义（P〈0．01）。冠心病期前收缩后T波倒置加深、ST段改变、T波改变伴ST段和／或U波异常较其它各疾病组明显增高，差异均有显著性意义（P〈0．05）。结论期前收缩后伴心肌复极异常主要见于心血管疾病，可提示为器质性期前收缩，有助于与功能性期前收缩相鉴别。对冠心病的诊断有一定意义。     

心得安试验QT离散度变化与QTd本质的研究

目的：研究心得安试验前后QT离散度(QTd)变化，探讨QTd的本质及评价其临床应用价值。方法：于经冠脉造影及其他检查除排除器质性心脏病，静息心电图有T波低平、双向、倒置或有u波的186例思考，观察心得安试验前、后QTd的变化。结果：(假定QTd＞50ms为异常)78例心得安试验阳性QTd异常率试验前、后分别为83．3％，11．5％，有显差异(P＜0．01)；108例心得安试验阴性QTd异常率试验前、后依次为77．8％，74、1％，无显差异(P＞0．05)。两组QTd异常率试验前无显差异，试验后有显差异(P＜0．01)。结论：非器质性心脏病心得安试验QTd变化提示QTd异常不能作为反映心肌复极的不均一性指标，预测恶性心律失常或心脏猝死，而只是反映T波非特异性异常的一个粗浅的量化指标，对QTd的临床应用宜慎重。     

心肌复极异常心电图表现与冠心病患者心肌酶谱指标的关系研究

目的探究心肌复极异常心电图表现与冠心病患者心肌酶谱指标的关系。方法选取2015年6月—2016年4月在清河县中心医院就诊的冠心病患者198例,分为稳定型心绞痛(SAP)组45例、不稳定型心绞痛(UAP)组78例、急性心肌梗死(AMI)组75例,另选取同期在本院体检健康者40例作为对照组。比较4组受试者心肌复极异常心电图表现及心肌酶谱指标〔天冬氨酸氨基转移酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)及乳酸脱氢酶(LDH)〕,并比较不同心肌复极异常心电图表现患者心肌酶谱指标。结果 AMI组、UAP组和SAP组患者ST段异常、T波异常发生率高于对照组,AMI组和UAP组患者ST段异常、T波异常发生率高于SAP组,AMI组患者ST段异常、T波异常发生率高于UAP组(P0.05);AMI组患者V2导联Tp-Te间期长于UAP组、SAP组和对照组(P0.05)。SAP组患者血清CK水平高于对照组(P0.05),而SAP组患者与对照组受试者血清AST、CK-MB、LDH水平比较,差异无统计学意义(P0.05);AMI组和UAP组患者血清AST、CK、CK-MB及LDH水平高于对照组,AMI组患者血清AST、CK和CK-MB水平高于UAP组(P0.05),而AMI组和UAP组患者血清LDH水平比较,差异无统计学意义(P0.05)。ST段异常患者血清AST、CK、CK-MB及LDH水平高于无ST段异常患者,T波异常患者血清AST、CK、CK-MB及LDH水平高于无T波异常患者(P0.05)。结论心肌复极异常心电图表现与冠心病患者心肌酶谱指标升高有关。     

期前收缩揭示房室结双径路传导2例

例1患者女性，72岁。既往有冠心病史。来我院查心电图（图1A）示：窦性心律，心率97次／分，P—R间期为0．18s，P’波为房性期前收缩，第1个P＇-R间期为0．48s，其后的窦性P波下传时P—R间期依次为0．34s、0．32s、0．24s、0．18s，第2个P’波为阻滞型房性期前收缩。心电图诊断：①窦性心律；②房性期前收缩后出现房窒传导的反文氏现象；     

冠心病与QTc离散度关系的探讨

本文分析了109例经冠状动脉造影证实的不同类型冠心病患者QTc离散度（QTcd），并与41例临床疑有冠心病而冠状动脉造影正常的患者进行了对照研究。结果显示：冠心病患者的QTcd明显高于对照组（P＜0．001）；单纯陈旧心肌梗塞组的QTcd明显高于心绞痛组（P＜0.05）；陈旧心肌梗塞合并室壁瘤组其QTcd显著大于未伴有室壁瘤组（P＜0．001），而前壁、下壁之间比较，QTcd无明显差异（P＞0．05）；此外，冠脉单支、双支及三支病变组之间QTcd无明显差异（P＞0．05）。提示：冠心病存在明显心肌复极差异，陈旧心肌梗塞伴室壁瘤时QTc离散度增加最显著，QTcd与梗塞部位及冠脉病变支数无关。     

平板运动负荷试验中冠心病患者QT间期的动态变化

目的观察冠心病患者平板运动负荷试验中QT间期的动态变化规律并探讨其机制。方法收集经冠状动脉造影确诊的冠心病患者21例和对照组20例,分析两组受试者冠状动脉造影前的平板运动负荷试验心电图,每位受试者测量50个点的RR间期、QTp间期和QTe间期,计算QTpc间期、QTec间期和Tp—Te间期。以RR间期为横坐标,QTp间期、QTe间期、QTpc间期、QTec间期或Tp—Te间期为纵坐标,作直线相关分析,求相关直线斜率。结果平板运动负荷试验伞程,冠心病组QTe／RR斜率高于对照组（P〈0．05）,而两组间QTp／RR、QTpc／RR、QTec／RR和Tp—Te／RR斜率比较差异无统计学意义（P〉0．05）;运动期,冠心病组QTe／RR和QTec／RR斜率高于对照组（P〈0．05）;恢复期,冠心病组QTpc／RR斜率高于对照组（P〈0．05）,Tp—Te／RR斜率低于对照组（P〈0．05）。冠心病组运动期QTe／RR、QTec／RR和Tp—Te／RR斜率高于恢复期（P〈0．05）,运动期QTpc／RR斜率低于恢复期（P〈0．05）。对照组运动期和恢复期QTe／RR、QTp／RR、QTec／RR、QTpc／RR和Tp．Te／RR斜率比较差异均无统计学意义（P〉0．05）。结论冠心病患者运动负荷试验中的QT滞后现象与交感神经张力异常增高和T波终末部的异常动态改变有关。     

急性冠状动脉综合征心电图改变的临床意义

目的 探讨急性冠状动脉综合征心电图改变的临床意义。方法 对104例接受经皮穿刺腔内冠状动脉成形术加支架植入术的急性冠状动脉综合征患者（Ⅰ组Q波心肌梗死54例、Ⅱ组非Q波心肌梗死12例和Ⅲ组不稳定心绞痛38例）的冠状动脉病变和心电图改变进行分析。结果 冠状动脉完全闭塞Ⅰ组占75．55％，Ⅱ组占33．33％，差异有显著性意义（P＜0．05）。Ⅲ组无冠状动脉完全闭塞。3例冠状动脉多支病变差异无显著性意义（P＞0．05）。Ⅰ组：前壁心肌梗死多于下壁（32／54：22／54），发生持续性窦性心动过速、三度房室传导阻滞、室性心律失常、死亡率高。Ⅱ组：广泛持续性ST－T改变或以T波深倒置演变特征或Q波迅速消失，ST－T动态改变。Ⅲ组：胸痛发作时ST－T改变或伪性改善，不发作时ST－T正常或仍有改变。结论 急性冠状动脉综合征心电图表现有多种形式。无Q波心肌梗死并不少见。心电图的易变性是急性冠状动脉综合征的特征之一。     

束支传导裂隙现象2例

例1 患者男性，82岁。临床诊断：冠心病。动态心电图（图1）示窦性心律，心率100次／min时P—R间期0．20s，QRS时间0．16s，MV，导联R波切迹。MV5导联S波增宽，为完全性右束支传导阻滞。而民与R7QRS波群呈rSr’型，时间0．10s，房性期前收缩代偿后的P7波下传的QRS波群恢复正常，揭示3相右束支传导阻滞。然而出现房性期前收缩P6波时，     

心室复极的性别差异相关因素分析

目的 探讨各心电图复极指标对不同性别相关因素的影响。方法 观察500例健康人反映复极时间和速率的心电图指标，在T波振幅最高的心前导联测量。结果 男性比女性心脏复极时间更短、速率更快，差异有非常显著性意义（P＜0．01）。非线性多因素回归分析表明，与性别差异相关的各参数中权重最多的J点和ST角。结论 复极早期时间和速率变化是不同性别相关心电图图形差异的决定因素。     

恶性肿瘤化疗与联合放化疗动态心电图对比分析

目的了解化疗及放化疗期间恶性肿瘤患者出现心慌、心悸等症状时心电图的改变。方法对尚未治疗组（A组）、化疗组（B组）及放化疗组（C组）恶性肿瘤患者在治疗期间出现心慌、心悸等症状时作24h动态心电图（DCG）,对其心率、期前收缩、异位心动过速及ST—T改变等进行对比分析。结果24h最高心率、最低心率、平均心率及24h总心率,B、c组与A组比较具有非常显著性差异（P〈0．01及O．001）。B与C组间平均心率、24h总心率有显著性差异（P〈0．05）,但最高心率、最低心率无显著性差异（P〉0．05）。〉100次／24h房性及室性期前收缩,A与B组间具有显著性差异（P〈0．05）,A与C组间具有非常显著性差异（P〈0．01）。B与C组间房性期前收缩具有显著性差异（P〈0．05）,但室性期前收缩无显著性差异（P〉0．05）。A与B及A与C组间短阵性房性心动过速具有非常显著性差异（P〈0．01）,但B与C组间无显著性差异（P〉0．05）。室性心动过速三组间无显著性差异（P〉0．05）。A与C组间ST—T改变具有非常显著性差异（P〈0．01）,但A与B及B与C间无显著性差异（P〉0．05）。结论化疗、放疗对心脏具有一定毒性作用,联合放化疗可加重二者的毒性作用。动态心电图可作为在化疗、放化疗时,对有症状性肿瘤患者的心脏毒性作用最简捷的监测方法,有利于临床医生及时调整方案。     

Postextrasystolic Changes in the Complexity of the QRS Complex and T Wave

We tested the hypothesis that ventricular repolarization of the first sinus beat following a ventricular premature beat (VPB) can be modulated in the absence of clearly discernible T‐wave changes. We applied principal component analysis (PCA) to assess QRS and T‐wave complexity of sinus beats preceding and following VPBs in multiple 10‐second resting 12‐lead electrocardiograms of two subjects with frequent VPBs and no apparent heart disease. In both subjects, T‐wave complexity of the first post‐VPB beat was significantly increased compared to the beats preceding the VPB.     

Enhancement of sympathetic nerve activity by single premature ventricular beats in humans

This is the first systematic study of the effects of ventricular premature beats on sympathetic nerve activity in humans. Microneurographic techniques were used to record efferent sympathetic activity from the peroneal nerve, and an intracardiac electrode catheter was used to introduce ventricular premature beats after every 6 to 10 sinus heartbeats. Studies were performed in eight patients, aged 22 to 74 years (mean 57), undergoing cardiac electrophysiologic studies. Three patients did not have apparent heart disease and five had coronary artery disease. During sinus rhythm, 19 to 93% (mean 42%) of heartbeats were followed by a pulse-synchronous burst of sympathetic activity. Provoked ventricular premature beats had obvious effects on this activity. Premature beats with coupling intervals less than 80% of sinus cycle length were consistently followed by a burst of sympathetic activity, and this activity was greater in amplitude, duration and area (all p less than 0.05) than were burst of such activity during sinus rhythm. The magnitude of this burst of activity increased as the coupling interval of the ventricular premature beat decreased (p less than 0.0001). In contrast, postextrasystolic beats were followed by nearly complete neural silence. These effects were seen in all patients regardless of baseline burst incidence and the presence or absence of heart disease. Total nerve activity per 10 heartbeats was 6,520 +/- 770 U during ventricular extrastimulation and 5,720 +/- 440 U during normal sinus rhythm (difference not significant). It is concluded that single ventricular premature beats provoke fluxes of muscle sympathetic nerve activity in humans, comprising surges of sympathetic activity larger than those occurring during sinus rhythm, followed by neural silence.     

室性逸搏心律并心室内反复搏动致干扰性房室脱节1例

本文报道1例扩张性心肌病患者心室短暂性逸搏心律并在心室内形成反复搏动,由于窦性激动下传时连续遇室性激动逆传所导致的不应期,故发生连续性的干扰而形成一过性房室脱节。     

对心脏早搏患者伴发的焦虑抑郁症状的治疗及其意义

目的观察评价无器质性心脏病心脏早搏患者焦虑抑郁心理障碍情况,及对抗焦虑抑郁药物治疗的临床疗效。方法对有心悸等心血管病症状的房性、室性早搏患者,进行焦虑抑郁心理量表评分,选择有焦虑抑郁状态心脏早搏患者,随机分成抗焦虑抑郁药物治疗(5羟色胺再摄取抑制剂)组及安慰剂对照组,进行六周的双盲治疗研究,观察两组患者临床症状改善程度以及对心脏早搏的影响。结果共入选心脏早搏患者138例,汉密尔顿焦虑量表21.02±4.19分;汉密尔顿抑郁量表16.70±3.42分,均伴有较明显的焦虑抑郁状态。117例完成试验。治疗组(n=60)和安慰剂组(n=57)治疗均能有效缓解患者临床症状(P<0.05),但治疗组较安慰剂组疗效更明显?P<0.05)。治疗前后室性早搏变化不明显?P>0.05),但房性早搏明显减少(P<0.05)。结论有持续心血管病症状的心脏早搏患者常伴有焦虑抑郁心理障碍,应用抗焦虑抑郁药物治疗,能有效缓解患者的临床症状,同时,减少房性早搏的发生。     

Post-extrasystolic potentiation without a compensatory pause in normal and diseased hearts.

Variables derived from left ventricular volume were used to study post-extrasystolic potentiation. Left ventriculograms were obtained from 11 healthy individuals and 49 patients with coronary heart disease (30 with a previous myocardial infarction and 19 without any signs of myocardial damage). Post-extrasystolic potentiation was induced by a regularly driven right atrial rhythm that was interrupted by one atrial extrasystole in such a way that the post-extrasystolic RR interval was kept equal to the basic RR interval. The left ventricular end diastolic volumes of the pre-extrasystolic and post-extrasystolic beats were equal. In all groups there was evidence of post-extrasystolic potentiation in one or more of the indices of left ventricular function (ejection fraction, mean normalised systolic ejection rate, and systolic volume, and stroke volume). Potentiation was especially evident in patients with left ventricular damage; this suggests that a compensating mechanism is an intrinsic property of the myocardium. The Frank-Starling mechanism does not contribute to the increased performance of the post-extrasystolic beat in normal individuals or in patients with coronary artery disease.     

Post-extrasystolic potentiation without a compensatory pause in normal and diseased hearts.

Variables derived from left ventricular volume were used to study post-extrasystolic potentiation. Left ventriculograms were obtained from 11 healthy individuals and 49 patients with coronary heart disease (30 with a previous myocardial infarction and 19 without any signs of myocardial damage). Post-extrasystolic potentiation was induced by a regularly driven right atrial rhythm that was interrupted by one atrial extrasystole in such a way that the post-extrasystolic RR interval was kept equal to the basic RR interval. The left ventricular end diastolic volumes of the pre-extrasystolic and post-extrasystolic beats were equal. In all groups there was evidence of post-extrasystolic potentiation in one or more of the indices of left ventricular function (ejection fraction, mean normalised systolic ejection rate, and systolic volume, and stroke volume). Potentiation was especially evident in patients with left ventricular damage; this suggests that a compensating mechanism is an intrinsic property of the myocardium. The Frank-Starling mechanism does not contribute to the increased performance of the post-extrasystolic beat in normal individuals or in patients with coronary artery disease.     

从频发室性早搏分布规律探讨中西医时间医学结合点

通过观察24 h动态心电图频发室性早搏（室早）的时间分布情况,研究频发室早24 h昼夜规律和中医时辰节律,并由子、卯、午、酉4个时辰为切入点,探讨中西医时间医学结合点。方法选取2012年1月至2014年6月在广东省中医院行24 h动态心电图诊断为频发室早者（诊断标准为24 h室早数＞500次）466例,录入患者的基本信息和每小时室早频数结果。将24 h频发室早分布数据视为圆分布资料,用PEMS 3．1统计软件求得其平均角并进行假设检验,统计分析室早发生时间的集中趋势。不同时间室早的比较采用SPSS 20．0统计软件做重复资料测量的方差分析。结果466例患者动态心电图的室早发作高峰时间段在17：49左右,对应于12时辰的酉时（17：00-19：00）;发生室早最少的时间段是子时（23：00-01：00）和卯时（05：00-07：00）。4个时辰的室早个数比较,差异有统计学意义（P＜0．05）。在24 h分布趋势图中,室早发生的高峰时间在18：00,低谷时间在04：00。结论本研究证实了频发室早的发生具有昼夜节律现象,24 h发生的高峰时间与中医酉时相对应,也与心肾精气活动规律和心肾相交关系相符,为中西医时间医学结合作了初步的探索。     

稳心颗粒与维拉帕米治疗室上性期前收缩疗效的对比研究

目的 :对比观察稳心颗粒与维拉帕米对室上性期前收缩的疗效及安全性。方法 :随机选取有明显临床症状的室上性期前收缩患者 112例。其中房性期前收缩 77例 ,交界性期前收缩 35例。随机分为 3组 ,稳心颗粒组 (n =4 0 ) :口服稳心颗粒 1包 (9g) ,tid ;维拉帕米组 (n =32 ) :口服维拉帕米 80mg ,tid ;稳心颗粒加维拉帕米组 (n =4 0 ) ,剂量与前两组相同 ,均 4周为 1疗程 ,观察用药前后临床症状、期前收缩次数及不良反应情况。结果 :稳心颗粒组有效率 72 .5 % ,维拉帕米组有效率 75 .0 % ,稳心颗粒加维拉帕米组有效率 95 .0 % ,服用稳心颗粒后患者心悸、胸闷症状明显少于服用维拉帕米者 (P <0 .0 5 )。结论 :稳心颗粒对室上性期前收缩的疗效与维拉帕米相似 ,但在临床症状的改善以及不良反应方面明显优于维拉帕米 ,与维拉帕米联合用药疗效增加 ,不良反应减少。     

Ventricular premature beats and anatomically defined coronary heart disease.

Ambulatory 24 hour electrocardiographic monitoring was performed in 124 patients before cardiac catheterization and coronary angiography. Ventricular premature beats were demonstrated in 83% of all patients. Ectopic activity persisted for at least 3 of the 24 hours in 75% of the 84 patients with coronary heart disease, 61% of 28 with other heart disease and in 24% of 12 normal subjects. The prevalence and grade of ventricular premature beats were increased in the 57 patients with multivessel disease compared with values in the 27 patients with one vessel disease (P less than 0.01). Findings in the latter group did not differ from those of normal subjects. The presence of elevated left ventricular end-diastolic pressure of asynergy was associated with increased ventricular ectopy. Of 15 patients having both asynergy and elevated left ventricular end=diastolic pressure (more than 19 mm Hg), 40% had paroxysms of ventricular tachycardia and 67% had coupled beats; these findings were present in 6 and 12%, respectively, of the 34 patients without asynergy or pressure abnormality (P less than 0.005). Repeat monitoring performed in 65 patients demonstrated greater reproducibility of advanced grades of ventricular premature beats among those with the most severe lesions. For the individual patient the prevalence and grade of ventricular ectopy may not always correlate with the severity of coronary artery disease or degree of left ventricular dysfunction.     

Relation between the site of origin of ventricular premature complexes and the presence and severity of coronary artery disease

The clinical implications of ventricular premature complexes in patients with coronary heart disease have received increasing interest. It has been suggested that ventricular premature complexes of right ventricular origin have more benign implications than those that originate from the left ventricle. To define more precisely the relation between the site of origin of ventricular premature complexes and the presence and severity of coronary heart disease in patients with a chest pain syndrome, 39 patients with ventricular premature complexes of right or left ventricular contour who were undergoing cardiac catheterization and coronary arteriography for evaluation of chest discomfort were studied. Ninteen patients had left and 17 had right ventricular premature complexes and 3 had both. Of the 19 with left ventricular premature complexes, 15 had coronary artery disease (12 with two or three vessel obstruction and 3 with single vessel obstruction). Four had normal cardiac catheterization studies. Twelve patients had asynergy on ventriculography. The 17 patients with right ventricular premature complexes had similar angiographic findings. Eleven of the 17 had coronary artery disease (8 with triple vessel disease and 3 with isolated obstruction of the left anterior descending coronary artery). Six had normal arteries. Eight of the 11 with coronary artery disease and right ventricular premature complexes also had asynergy. All three patients with both left and right ventricular premature complexes had coronary obstructive disease. These findings indicate that in patients with a chest pain syndrome there is no relation between the site of origin of ventricular premature complexes and either the prevalence or severity of coronary artery disease.