动态心电图在病态窦房结综合征诊断中的应用价值

目的探讨动态心电图在病态窦房结综合征诊断中的应用价值。方法选取60例病态窦房结综合征患者作为观察组,并选取60例健康组作为对照组,进行24 h动态心电图检查,比较两组的检查结果。结果观察组24 h总心搏数、最高心率、最低心率、24 h平均心率均低于对照组,差异有统计学意义（P〈0.05）;观察组发生窦性心动过缓、窦性停搏、慢快综合征等心律失常的患者高于对照组,差异有统计学意义（P〈0.01）。结论动态心电图具有简单、无创伤、重复性强的特点,可作为病态窦房结综合征检查的首选方法。     

病态窦房结综合征110例动态心电图分析

目的了解病态窦房结综合征患者的动态心电图特点。方法对110例病态窦房结综合征患者进行动态心电图监测,对其结果进行分析。结果动态心电图检测结果,长R-R间期是最主要、最常见的表现。缓慢性心律失常:显著的窦性心动过缓85例(77.27%)、窦性停搏33例(30.00%)、窦房阻滞15例(13.64%)、房室阻滞17例(15.45%)。快速性心律失常:短阵性房性心动过速27例(24.55%)、阵发性心房颤动26例(23.64%)。A型和C型患者24h总心搏数<8万、平均心率<50次/min、最高心率<90次/min,绝大多数最低心率发生于23:00~5:00,以35~40次/min居多。B型患者因有反复的快速房性心律失常发生,其24h总心搏数、平均心率、最高心率并不低于一般监测人群。结论病态窦房结综合征可出现多种心律失常,晕厥与长R-R间期有明确的相关性,动态心电图能协助临床诊断和治疗的判断。     

动态心电图诊断病态窦房结综合征的价值

目的探讨动态心电图诊断病态窦房结综合征的价值。方法对100例病态窦房结综合征患者(观察组)和100例体检者(对照组)均行12导联动态心电图监测,对比分析2组检查结果。结果观察组中Ⅰ型病窦综合征22例(22.00%),Ⅱ型病窦综合征34例(34.00%),Ⅲ型病窦综合征34例(34.00%),Ⅳ型病窦综合征10例(10.00%)。观察组24h总心搏数、24h心率、最高心率、最低心率值均明显低于对照组,窦性心动过缓、窦性停搏、心房颤动、阵发性室上性心动过速、窦房传导阻滞、房室传导阻滞、希氏-浦肯野系统传导异常检出率均明显高于对照组(均P<0.01)。结论病态窦房结综合征患者的动态心电图与正常人群明显不同,动态心电图是早期诊断病态窦房结综合征的可靠的方法。 更多还原     

96例急性窦房结功能不全病因和心律失常类型的临床分析

目的观察临床上较少见的急性病态窦房结功能不全（病窦）的病因组成、临床表现、心律失常类型及治疗效果。方法我院自1992年1月至2004年12月收治急性病窦患者96例，对其病因、临床特点进行统计分析。结果急性窦房结功能不全的病因以急性心肌梗死最为常见，占64％；其次为病毒性心肌炎占22％。心律失常以单纯窦性心动过缓为表现超过半数达54％，其次为窦性停搏占29％；窦房阻滞为20％，慢快综合征15％，窦房结和房室结双重病变17％。经积极治疗大部分在48h内恢复，仅有3例转为慢性病窦。结论急性病态窦房结功能不全以急性心肌梗死并单纯窦性心动过缓最为常见，及时发现，恰当治疗大多能恢复正常窦性心律。     

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。     

病态窦房结综合征232例动态心电图分析

目的探讨病态窦房结综合征患者动态心电图特征及其临床意义。方法对232例动态心电图进行回顾性分析,依据动态心电图特征进行分型。结果Ⅰ型（持续而严重的窦性心动过缓）37例,Ⅱ型（窦性心动过缓伴窦性停搏或窦房阻滞）70例,Ⅲ型（慢-快综合征）52例,Ⅳ型（双结病变）73例。结论植入合适的永久人工心脏起搏器,对病态窦房结综合征患者可起到积极良好的治疗作用。     

窦性心动过缓患者颈动脉粥样硬化斑块内膜剥脱术后心率回升1例

患者男，72岁，以”心率渐进性减慢伴胸闷3d”入院，无头晕、心悸、恶心、视物模糊及耳鸣等症状，多次查心电图示：窦性心动过缓，静息心率由60次／min逐渐减至46次／min，无明显缺血性ST-T改变；心肌酶学指标均正常：血钾正常；心脏超声示左室顺应性减低，收缩功能正常。既往有“原发性高血压”40余年、“高脂血症”30余年病史，未服用心脏负性频率药物。入院后行食道电生理调搏检查示：窦房结恢复时间1640ms，窦房结传导时间320ms，房室结文氏点110次／min，阿托品试验提示窦房结功能低下。考虑病态窦房结综合征（双结病变）可能，经心宝、生脉等提升心率药物治疗，效果欠佳，多次24h动态心电图示间歇性窦性心动过缓，     

动态心电图在病态窦房结综合征诊断中的应用价值

目的评价动态心电图在病态窦房结综合征诊断中的应用价值。方法选取73例病态窦房结综合征患者作为观察组,另选取同期来我院体检的73例健康者作为对照组,两组研究对象均行动态心电图检查,比较两组人群的检查结果,分析动态心电图特征。结果观察组患者动态心电图检测出心律失常67例,检出率为91.8%,显著高于对照组的57.5%,差异有统计学意义(P0.05)。观察组患者的最高心率、最低心率及24h平均心率均低于对照组,差异有统计学意义(P0.05)。结论动态心电图在病态窦房结综合征诊断中具有重要的临床应用价值,值得进一步推广使用。     

病态窦房结综合征患者的动态心电图特征

目的：探讨病态窦房结综合征患者的动态心电图特征。方法：选用经临床心脏电生理检查证实的54例病态窦房结综合征患者进行24h动态心电图检查。并选30例正常人进行对照。结果：患者组心率明显慢于对照组，两者差异具有显著性（P〈0.001）。患者组心律失常检出率明显高于对照组。结论：动态心电图能提供较多的心率和心律变化资料，适用于间歇性心率和心律改变的病态窦房结综合征患者，能明显提高其心律失常的检出率。     

病态窦房结综合征：心律失常讲座（3）续前

引言病态窦房结综合征（ＳＳＳ）简称病窦综合征，是指持续性心动过缓、窦房结外传阻滞、窦性停搏、心动过缓－心动过速综合征这四种主要窦性心律紊乱所致的临床症候群。目前虽然其确切的患病率尚不清楚，但它已占安置起搏器患者的半数以上，因此，是临床常见的严重心律失...     

中药干预对成人心肌炎患者窦性心率震荡及血清心肌损伤指标的影响

目的探讨中药干预对成人心肌炎患者窦性心率震荡及血清心肌损伤指标的影响。方法采用随机数字表法将患者分为研究组、对照组，对照组患者进行常规西药治疗，研究组除进行常规内科治疗外，还辅以参松养心胶囊、丹红注射液治疗。于入组时及治疗15d后分别对心电图窦性心率震荡（HRT）、及血清心肌肌钙蛋白T（cTnT）、高敏C反应蛋白（hs—CRP）、肌酸激酶同功酶（CK—MB）进行测评，并比较治疗15d后的临床疗效。结果两组治疗后震荡初始（TO）值均显著降低，而震荡斜率（TS）值均显著增加（P〈0．05）；治疗后研究组TO、TS值变化更明显（P〈0．01）。两组治疗后血清cTnT、hs—CRP、CK—MB水平均显著降低，较治疗前均差异有显著统计学意义（P〈0．01），血清cTnT、hs．CRP、CK-MB水平治疗后研究组降低更明显（P〈0．01）。治疗15d后两组心电图改善情况、临床症状改善情况研究组显著好于对照组（P〈0．05）。结论采用中药参松养心胶囊、丹红注射液干预成人心肌炎的治疗，较单用常规西药者，能更有效地改善HRT指标，降低血清cTnT、hs—CRP、CK—MB水平。     

Diagnosis and treatment of sick sinus syndrome

Sick sinus syndrome comprises a variety of conditions involving sinus node dysfunction and commonly affects elderly persons. While the syndrome can have many causes, it usually is idiopathic. Patients may experience syncope, pre-syncope, palpitations, or dizziness; however, they often are asymptomatic or have subtle or nonspecific symptoms. Sick sinus syndrome has multiple manifestations on electrocardiogram, including sinus bradycardia, sinus arrest, sinoatrial block, and alternating patterns of bradycardia and tachycardia (bradycardia-tachycardia syndrome). Diagnosis of sick sinus syndrome can be difficult because of its nonspecific symptoms and elusive findings on electrocardiogram or Holter monitor. The mainstay of treatment is atrial or dual-chamber pacemaker placement, which generally provides effective relief of symptoms and lowers the incidence of atrial fibrillation, thromboembolic events, heart failure, and mortality, compared with ventricular pacemakers.     

Atrioventricular block/sick sinus syndrome

Dizziness, black spell, syncope, short of breathness and heart failure due to cardiac arrest or severe bradycardia are often observed in patients with atrioventricular(AV) block or sick sinus syndrome(SSS). Not only danger of cardiac sudden death but also accidents such as bone fractures, traffic accidents are great problems especially in elderly patients. These symptoms are improved by pacemaker implantation. Atrial fibrillation is often observed in patients with brady-arrhythmias, especially in patients with sick sinus syndrome. High incidence of cerebral embolisms is also great problems. Specificity of electrophysiological study for brady-arrhythmias are high but sensitivity is not enough. Diagnosis of AV block and sick sinus syndrome can be determined by medical histories, conventional ECG and Holter ECG.     

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.     

彩色多普勒超声在诊断自发性脾肾分流中的应用

目的　探讨自发性脾肾分流的超声表现及彩色多普勒超声在诊断自发性脾肾分流中的价值。方法　运用彩色多普勒超声对 18例经临床证实的肝硬化门脉高压伴自发性脾肾分流的患者进行研究 ,并与 12例肝硬化门脉高压不伴自发性脾肾分流的患者进行对照。结果　 18例自发性脾肾分流的患者中 ,11例患者脾静脉与左肾静脉间可见交通支形成。 14例患者脾静脉呈离肝血流 ,3例呈双向血流 ,1例为向肝血流。脾门区脾静脉曲张例数较对照组明显增多 (P<0 .0 1) ,左肾静脉较对照组明显增宽 (P<0 .0 1)。左肾静脉血流速度较对照组明显增快 (P<0 .0 1)。结论　彩色多普勒超声能较好地显示脾肾静脉间交通支及其血流动力学的变化 ,可为临床提供可靠的诊断依据 ,是诊断脾肾静脉分流的好方法     

病态窦房结综合征动态心电图分析

目的探讨动态心电图(DGG)在病态窦房结综合征(SSS)的诊断和分型中的临床价值。方法 2008年1月至2010年10月收治的SSS患者136例作为观察组,选择同期收治的50例健康者为对照组,进行动态心电图检测。结果观察组在总心率、平均心率、最高心率及最低心率均明显低于对照组,两组比较差异显著(P<0.05)。SSS分型其中I型43例(31.6%),Ⅱ型21例(15.4%),Ⅲ型47例(34.6%),Ⅳ型25例(18.4%)。结论 DGG可辅助SSS明确诊断和分型,操作方便简单,可为临床治疗提供可靠的参考价值,值得临床推广应用。     

Bradyarrhythmia Profile and Associated Diseases in 1,265 Patients With Cardiac Pacing

Twelve hundred and sixty-five patients with implanted cardiac pacemakers were reviewed for known associated conditions and for the resulting bradycardia patterns. The group bradyarrhythmia profile was AV block in 75%, sick sinus syndrome (SSS) in 21% and combined arrhythmias in 4%. Thyroid diseases and acquired valvular disease were frequently associated with AV block especially of the Wenckebach type. Sick sinus syndrome occurred significantly more frequently in women (28%) than in men (26%). Isolated bradyarrhythmias (i.e., with no associated disease) were 22% of the entire group with a 26% incidence of SSS and with a significant association with previous gastric resection, pernicious anemia, and malabsorption compared to the groups with other associated diseases. Degenerative cardiac lesions caused by malabsorption and undiagnosed hypothyroidism in elderly women may contribute to the group of apparently isolated bradyarrhythmias.     

Chronotropic effect of the antithrombotic agent cilostazol in a patient with sick sinus syndrome and syncope

In this case report we describe an 80-year-old man with sick sinus syndrome (SSS) who developed syncope attacks. The diagnosis of SSS was based on electrocardiographic evidence of markedly prolonged sinus arrests associated with syncope attacks while in hospital. The patient was given cilostazol, an antithrombotic agent that selectively inhibits cyclic nucleotide phosphodiesterase type 3, at a dose of 100 mg twice daily. The syncope attacks ceased, and an electrocardiogram obtained 1 week after the start of cilostazol administration showed no evidence of sinus arrest. The outcome of this case suggests that cilostazol may be useful in patients with syncope attacks due to SSS, although the long-term chronotropic effects of cilostazol need to be evaluated.     

温奇扶元法治疗病态窦房结综合征的临床研究

目的:评价温奇扶元法对病态窦房结综合征(SSS)的疗效及治疗价值。方法:采用随机对照法,将68例SSS患者分为治疗组和对照组,治疗组33例,在常规治疗的基础上给予温奇扶元方;对照组35例,给予常规治疗,4周后比较两者临床表现及心电图变化。结果:(1)临床疗效:治疗组和对照组总有效率分别是90.91%和71.43%,两组差异有显著性(P<0.05);(2)24h动态心电图:治疗组患者治疗后最高心率明显提高(P<0.05),而最低心率、平均心率提高更为明显(P<0.01)。结论:温奇扶元法治疗病态窦房结综合征有明显疗效。