恢复期亚急型和慢型克山病患者动态心电图特点及预后意义

目的 观察恢复期亚急型和慢型克山病患者动态心电图（DCG）特点，探讨其预后意义。方法 选择恢复期亚急型和慢型克山病患者88例，进行心电图（ECG）和DCG检查，并长期随访，以观察终点结果死亡或存活分组对比分析。结果 恢复期亚急型克山病患者在ECG90．3％正常情况下，84．9％的DCG出现异常。慢型ECG及DCG异常检出率都很高，分别为94．7％和100．0％。亚急型DCG异常检出率室早最高，为77．4％，其中成对室早51．6％，室速32．3％；房早次之41．9％。慢型DCG异常检出率室早最高，为96．5％，其中频发室早75．4％，成对室早51．6％，室速32．3％；房早次之82．2％。死亡组与存活组对比，死亡组ECG房早、室早、ST-T改变较存活组检出率高（P〈0．05）。死亡组与存活组DCG室早总检出率无差异（P〉0．05），但成对室早和室速检出率较存活组高（P〈0．05）。结论 房性与室性心律失常是恢复期亚急型和慢型克山病的DCG特征，亚急型ECG正常，DCG高异常检出率；慢型ECG及DCG均高异常检出率。成对室早和室速对预后有重要意义。

The clinical features and prognostic meanings of dynamic electrocardiogram on recover-term subacute and chronic Keshan disease

Objective To observe the clinical features and to explo re prognostic meanings of dynamic electrocardiogram on recover-term subacute and chronic Keshan disease.Methods Thirty-one recover-term subacute patents and57chronic Keshan patents were selected from Shandong epidemic area of Keshan disease.They were checked up by electrocardiogram(ECG)and dynamic electrocardiogram(DCG)and were followed-up for long term.All patents were divided into2groups(survive and death groups),which were analysed by comparative methods.Results Normal ECG was90.3%and subnormal DCG was84.9%in recover-term subacute patents.The incidence rate of subnormal ECG and DCG were all high in chronic Keshan disease.The incidence rate of ventricular premature was77.4%,frequent ventricular premature25.8%,pair ventricular premature51.6%,ventricular tachycardia32.3%in subnormal DCG of recover-term subacute patents.The incidence rate of ventricular premature was96.5%,frequent ventricular premature75.4%,pair ventricular premature77.2%,ventricular tachycardia59.6%,atrial premature82.2%in subnormal DCG of chronic patents.The subnormal DCG on survive groups was compared with death groups.The incidence rate of atrial premature,ventricular premature and ST-T change in subnormal ECG of were higher than that in survive groups(P<0.05).The incidence rate of frequent ventricular premature,pair ventricular premature and ventricular tachycardia of DCG in death groups were higher than that in survive groups(P<0.05).Conclusions The atrial and ventricular cardiac arrhythmia are the features of ECG and DCG in recover-termsubacute and chronic Keshan disease.ECG is normal,DCG subnormal in recover-term subacute patents but ECG and DCG are all subnormal in chronic patents.The pair ventricular premature and ventricular tachycardia are important for prognosis.