心力衰竭患者左室增大与心功能及室性心律失常的关系

目的 探讨左室增大的心力衰竭患者的心功能情况及室性心律失常的特征.方法 选择2013年1月至2015年6月在沈阳市第十人民医院心内科住院的心脏彩超提示左室舒张末期内径(LVEDd)>55 mm的心力衰竭患者121例,按照LVEDd分为A组(LVEDd≤65 mm)82例和B组(LVEDd>65 mm)39例,采用NYHA分级评价心功能,根据Schamroth室性早搏形态、起源部位及Lown分级法比较24 h动态心电图的室性心律失常的特点.结果 ①A组心功能以Ⅱ、Ⅲ级为主,B组心功能以Ⅲ、Ⅳ级为主;②B组病理性室性早搏发生率高于A组;两组室性早搏多起源于左室;在LownⅢ级以下,A组发生率比B组高,差异有统计学意义(P<0.05);在LownⅢ级以上,B组发生率比A组高,差异有统计学意义(P<0.05).结论 左室增大的程度与心功能级别相关.对室性心律失常患者进行Schamroth室性早搏形态、起源部位及Lown分级法的综合分析,有助于区分室性心律失常的性质.

Relationship of left ventricular enlargement with cardiac function and ventricular arrhythmia

Objective To investigate the features of cardiac function and ventricular arrhythmia in the heart failure patients with left ventricular enlargement. Methods 121 cases of heart failure patients hospitalized in our hospital from Jan 2013 to Jun 2015, with their echo-cardiography results of left ventricular end-diastolic diameter ( LVEDd) >55 mm, were selected and divided into group A ( LVEDd≤65 mm, 82 cases) and group B (LVEDd >65 mm, 39 cases). According to the NYHA grade system of cardiac function, the features of ven-tricular arrhythmias from 24-hour dynamic electrocardiogram between the two groups, such as Schamroth morphology of ventricular prema-ture beats, area of origin and Lown grading, were compared. Results The cardiac function of group A was mainly in grade Ⅱ and Ⅲ, and it was usually in grade Ⅲ and Ⅳ in group B. The incidence of pathological ventricular premature beats in group B was higher than that in group A, and most ventricular premature beats in the two groups originated from the left ventricle. If the premature beat was inferior to Lown grade Ⅲ, the incidence of group A was higher than that of group B, with statistically significant difference (P<0. 05);and if it was superior to Lown grade Ⅲ, the incidence of group B was significantly higher than that of group A (P<0. 05). Conclusion The degree of left ven-tricular enlargement may be associated with the grade of cardiac function. The comprehensive analysis of ventricular arrhythmias with Scham-roth morphology of ventricular premature beats, area of origin and Lown grading would be helpful to distinguish their features and show strong clinical guiding significance.