有症状早搏患儿心率变异性的临床研究

目的 调查有心前区不适儿童早搏发生率,明确早搏与心率变异性(heart rate variability,HRV)的关系.方法 426例3～12岁有心前区不适儿童行24 h HRV时域分析;房性早搏(房早)、室性早搏(室早)按照Lown分级法分级,进行HRV分析.结果 (1)426例儿童中201例(47.2%)无任何心律失常.225例(52.8%)有早搏,其中单纯室早102例(23.9%),单纯房早77例(18.1%),同时合并房早、室早46例(10.8%).(2)在房早儿童中SDANN、PNN50值随着Lown分级升高而变化,差异具有显著性(F=4.39,P＜0.05;F=3.55,P＜0.05).2级以上房早儿童SDANN、PNN50值较0、1级儿童显著升高(P＜0.05);(3)在室早儿童中SDANN、RMSSD、PNN50值随着Lown分级升高而变化,差异具有显著性(F=3.61.P＜0.05;F=3.25,P＜0.05;F=2.63,P＜0.05).(4)有早搏儿童SDNN值较无早搏儿童差异无显著性(F=1.84,P＞0.05),SDANN、RMSSD、PNN50值差异有显著性(F=4.28,P＜0.05;F=2.72,P＜0.05;F=3.27,P＜0.05).结论 有心前区不适的儿童早搏发生率高于正常儿童,室早较房早发生率高.此类儿童有无早搏时心脏自主神经总张力是一致的,早搏的发生与交感神经张力增强、迷走神经紧张性抑制作用减弱有关.合并早搏时HRV均显著降低,室早降低最明显.无器质性心脏病儿童出现早搏可能系心脏自主神经功能紊乱所致,应用HRV分析鉴别早搏的性质具有临床意义.

Research on heart rate variability of children with symptomatic premature contraction

Objective To investigate frequency of the premature contraction in children with heart complain and the correlation with heart rate variability(HRV).Methods Routine ECG and Holter were used to record the HRV for 426 cases ehildren aged from 3 to 12 years old.The organic heart diseases or other chronic diseases were ruled out depending on history of disesse and physical or chemical examination.Four long time-domain indexes of HRV were adopted.The severity of premature contraction was determined according to Lown degree.Results (1)201(47.2%)children had 110 arrthymia in 426 cases with heart complain,225(52.8%)childrenwerefound prematurecontraction,induding 102(23.9%)childrenwere pure ventricular premature contraction,77(18.1%)children were pure atrial premature contraction and 46(10.8%)children had both.(2)The values of SDANN and PNN50 varied by increasing of the class of Lown degree in all atrial premature contraction children(F=4.39,P＜0.05;F=3.55,P＜0.05).The SDANN and PNN50 in the second grade were higher than those in other two grades(P＜0.05).(3)The values of SDANN,RMSSD,and PNN50 changed with increasing of the class of Lown degree in an ventricular premature contrac tion children(F=3.61,P＜0.05;F:3.25,P＜0.05;F=2.63,P＜0.05).(4)There wssn't significant differenee in SDNN value between children with premature contraction and without premature contraction (F=1.84,P＞0.05).Significant differences were found in the values of SDANN,RMSSD,and PNN50(F=4.28,P＜0.05;F=2.72,P＜0.05;F=3.27,P＜0.05).Conclusion The frequency of premature contraction in children with heart complain was higher than that in normal children.The number of ventrieular premature contraction was higher than atrial premature contraction.There was no difference in the tital tensity of heart automatic nervous between the children with premature contraction and without premature corltraction.HRV in premature contraction children was decreased significandy,especially in the ventricular premature contraction.It has dinical significance to distinguish the characteristics of premature contraction by the analysis of HRV.