北京地区3至12岁1581例健康儿童心率变异性分析

目的 探讨健康儿童早搏、房室传导阻滞、心率变异性（heart rate variability,HRv）与年龄、性别的关系.方法 1581例健康儿童分为3～6岁、～10岁、～12岁3组,按年龄、性别及室性早搏发生与否分组进行心律失常发生率、HRV的5项时域值的比较.结果 （1） ECG和24h心电监测（Holter）示健康儿童的平均心率、最慢心率和最快心率随年龄增加而降低,PR、QTc间期相反,除PR间期外其余各项指标差异均有统计学意义（P＜0.01）.（2）健康儿童Holter和ECG心律失常阳性检出率差异有统计学意义（x2 =4.810,P＜0.05）.（3）不同年龄组室上性早搏、室性早搏、Ⅰ.房室传导阻滞的发生率差异有统计学意义（P＜0.05）,且随年龄增长有升高或下降趋势;与3～6岁组比较,～ 10岁和～12岁组室性早搏发生危险度明显增加（OR =1.31和2.04）.（4） HRV的5项时域指标值随年龄增长而增高,各年龄组比较差异有统计学意义（P＜0.01）.（5） HRV的5项时域指标值男性均高于女性（P＜0.01）.（6）按室性期前收缩分组,HRV的5项时域指标差异均无统计学意义（P＞0.05）.结论 （1）健康儿童的心率随年龄增长逐渐下降,QTc间期随年龄增加而延长.（2）健康儿童Holter检测心律失常中室上性早搏的发生率最高.（3）健康儿童中室上性早搏、室性早搏的发生随年龄增长而增多,青春前期更明显.Ⅰ°房室传导阻滞的发生随年龄的增长有下降趋势.上述类型心律失常的发生与性别无关.（4）健康儿童HRV存在年龄差异,提示儿童心脏自主神经系统发育尚不成熟.（5）青春期前,男女间HRV的差异最为显著,提示可能此年龄段男女间心脏自主神经发育的不一致性.（6）健康儿童室性早搏的发生大部分为良性早搏.

Study of heart rate variability among 1581 normal children from age 3 to 12 in Beijing

Objective To investigate the correlation between premature beats,atrioventricular block （AVB）,heart rate variability （HRV） and age as well as gender among normal children.Methods One thousand five hundred and eighty-one cases of normal children from Beijing were divided into three age groups：3 to 6-year old,～ 10-year old and ～ 12-year old.All children were evaluated with both ECG and Holter to determine arrhythmia and HRV.The arrhythmia incidence and five time-domain values of HRV were analyzed according to age,gender and the existence of ventricular premature contractions.Results （1） Both ECG and 24-hour ECG monitoring （Holter） data showed that the average heart rate （HR）,the slowest HR and maximum HR of normal children decreased with age,while PR interval and QTc interval increased with age.The correlation between age and the four indices were statistically significant （P ＜0.01）,except the PR interval.（2） The positive rate of arrhythmia with Holter and ECG in normal children had statistically significant difference（x2 =4.810,P ＜ 0.05）.（3） The incidence of premature contraction and Ⅰ ° AVB rised or fell with increasing age（P ＜ 0.05）.Compared with 3 ～6-year age group,10-year and ～ 12-year old group had highly risk tendency in premature contraction（OR =1.31,2.04）.（4） The five time-domain indices of HRV were increases with age.Each age group had statistically significant difference （P ＜ 0.01）.（5） The five time-domain indexes of HRV in males were higher than those in females （P ＜0.01）.（6） No significant differences were found with five time-domain indexes in children with or without ventricular premature contraction （P ＞ 0.05）.Conclusions （1） HR of normal children decreases with age,but QTc interval increases with age.（2） The supraventricular premature contraction is the most common arrhythmia in normal children with Holter.（3） The occurrence of premature contractions increases with age,more obvious during the preadolescence.Ⅰ ° AVB occurs with age growth on a downward trend.Sex has no effect on the same arrhythmia.（4） HRV in normal children has age difference,suggesting that the pediatric cardiac autonomic nervous system （ANS） was immature.（5） The differences of HRV in sex were most significant during the preadolescence,which showed the developmental inconsistencies in cardiac ANS between male and female of preadolescence.（6） In the majority of normal children,the ventricular premature contractions were benign.