儿童心肌炎动态心电图监测临床价值探讨

目的：目前诊断病毒性心肌炎的标准仍是采用临床、心脏器械和实验室检查相结合的方法综合判断。该文对儿童心肌炎动态心电图(DCG)监测下心电变化特点作一回顾性分析，旨在为临床诊断、治疗及预后判断提供重要依据。方法：分析59例儿童心肌炎及41例无器质性心脏病对照组的心电图变化,测定DCG异常率、室性早搏数量、级别及分布情况、心率变异指标。 结果：心肌炎组异常DCG检出率86.4%，且部分为复合心律失常，与对照组DGC异常检出率46.3%相比，差异非常显著﹙P<0.01﹚。室早分布类型心肌炎组以均匀型（84.6%﹚及单峰型﹙64.4%﹚最常见，与对照组比较差异有显著性﹙P<0.05，P<0.01﹚。 结论： 儿童DCG监测异常、早搏分布为均匀型、早搏高峰为单峰及多峰型者或出现复合心律失常对儿童心肌炎的诊断、治疗及预后判断有一定参考价值。［中国当代儿科杂志，2007，9（3）：213-215］

Clinical value of 24-hour ambulatory electrocardiography in childhood myocarditis

Objective To investigate the characteristics of 24-hr ambulatory electrocardiography (DCG) of children with myocarditis and to study the clinical value of DCG in the diagnosis of childhood myocarditis. Methods 24-hr DCG findings, including abnormal DCG rate,and number, grade and distribution of ventricular premature beat (PVC), as well as heart rate variability, from 59 children with myocarditis were retrospectively reviewed and compared with those detected in 41 children without heart disease. Results 86.4% of patients with myocarditis showed abnormal DCG, and compound arrhythmia was commonly seen, but only 46.3% showed abnormal DCG (P<0.01) and single arrhythmia was predominant in the control group. The number and grade of PVC/24 hrs were not significantly different between the two groups. Compared with the control group, the average pattern PVC was predominant in the myocarditis group (84.6% vs 48.7%; P<0.05). Monopeak pattern PVC was mostly seen (64.4%), followed by multiple-peak pattern (25.4%) and bi-peak pattern (8.4%) in the myocarditis group, which were significantly different from the control group: monopeak pattern 53.6%, bi-peak pattern 36.6% and multiple-peak pattern 7.3% (P<0.01).Conclusions The 24-hr DCG characteristics of children with myocarditis are different from the normal controls, suggesting 24-hr DCG monitoring is useful to the diagnosis of childhood myocaditis.