动态心电图对窦房结功能的评估研究

目的评价动态心电图对窦房结功能的诊断价值。方法将60例窦性心动过缓患者根据阿托品试验结果分为病态窦房结综合征（病窦组）28例和单纯窦性心动过缓（单纯窦缓组）32例，比较两组动态心电图（DCG）、心率和心律失常情况；对病窦组行食管心房调搏术，分析电生理结果与DCG结果的相关性；对单纯窦缓组进行随访和复查。结果病窦组24hDCG总心率[（77460．4±2612．3）次]和平均心率[（53．8±3．2）次／min]低于单纯窦缓组[分别为（79159．5±3245．2）次、（56．1±3．7）次／min]（P〈0．05）．最高心率和最低，心率显著低于单纯窦缓组（P〈0．01）；严重窦性心动过缓、窦性停搏、窦房阻滞、交界性逸搏发生率高于单纯窦缓组（P〈0．05）；DCG间歇时间与窦房结恢复时间（SNRT）间存在明显的正相关（r=0．56，P〈0．05）。单纯窦缓组有8例DCG符合病窦，随访3～6年后，均诊断病窦。结论DCG检测窦房结功能敏感性高，有助于诊断慢快综合征和双结病变，对DCG窦房结功能异常者，宜作长期随访。

Study on evaluation of dynamic electrocardiogram for sinus node function

Objective To evaluate the diagnostic value of dynamic electrocardiogram for sinus node function and follow-up information. Methods 60 patients with sinus bradycardia were divided into the following two groups: 28 patients in a group with sick sinus syndrome and 32 patients in a group with sinus hradycardia. according to the results of atropine test. DCG was recorded in all patients, heart rate and arrhythmia were compared. transesophageal atrial pacing(TEAP) was performed in sick sinus syndrome group,then to analyze the relationship between electro-physiological and DCG changes; Another group were followed up. Results Total heart rate of 24h and average heart rate were lower than those in sinus brad3'cardia group(P< 0. 05) ,maximum heart rate and minimum heart rate in sick sinus syndrome group were significantly lower than those in sinus bradycardia group(P < 0. 01); There was a higher incidence of severe sinus bradycardia,sinus arrest,sino-atrial block or atrio-ventricular functional escape beat in group than that in sinus bradycardia group ( P < 0. 05), the time of long intermittent in DCG showed significantly positive correlation with the SNRT(r=0. 56, P < 0. 05). 8 DCG present sick sinus syndrome in sinus bradycardia group,followed up for 3 to 6 years all diagnosed sick sinus syndrome. Conclusion DCG has better sensitivity in the detection of the function of sinus node,it is helpful to diagnose brady-techycardia syndrome and two knot pathology, long-term follow up should be done for the patients with sinus node dysfunction.