本文選題：長短周期現(xiàn)象　切入點(diǎn)：快速性室性心律失常　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過對動態(tài)心電圖診斷快速性室性心律失常病例觀察研究,分析其常見誘發(fā)因素,測量室早前RR間期、聯(lián)律間期、兩者比值,對比分析觸發(fā)快速性室性心律失常的室早的特征,探討室早合并的或房顫自發(fā)形成長短周期現(xiàn)象與快速性室性心律失常的發(fā)生及其連綴現(xiàn)象的相關(guān)性,從而深入地了解快速性室性心律失常的觸發(fā)和維持機(jī)制,為臨床評估室性心律失常危險分級提供更多客觀的參考指標(biāo),有助于臨床上更好地防治快速性室性失常事件的發(fā)生。方法:收集動態(tài)心電圖診斷存在快速性室性心律失常病例(50例)作為觀察組,另外選擇同期行動態(tài)心電圖診斷為單發(fā)室早無伴發(fā)快速性室性心律失常病例(49例)作為對照組,選取兩組動態(tài)心電圖中數(shù)據(jù)進(jìn)行對比分析,統(tǒng)計分析快速性室性心律失常的常見觸發(fā)因素,并分別測量兩組室早的前RR間期、聯(lián)律間期、兩者比值,比較兩組間是否存在統(tǒng)計學(xué)差異性,進(jìn)一步選取兩組間存在長短周期現(xiàn)象病例進(jìn)行統(tǒng)計分析,評價長短周期現(xiàn)象對觸發(fā)快速性室性心律失常的相關(guān)性。將觀察組分為存在連綴現(xiàn)象組和非連綴現(xiàn)象組,統(tǒng)計分析合并長短周期現(xiàn)象室早觸發(fā)的快速性室性心律失常是否更加容易發(fā)生連綴現(xiàn)象,通過觀察快速性室性心律失常發(fā)生前后的心電圖特征分析,進(jìn)而探討快速性室性心律失常的觸發(fā)和維持機(jī)制。成果:兩組動態(tài)心電圖數(shù)據(jù)對比分析結(jié)果顯示,(1)觀察組50個病例中共發(fā)生快速性室性心律失常531陣,其中490陣/次(92.28%)由室早觸發(fā);(2)觀察組中室早的前 RR 間期較對照組明顯延長(909.73+283.22ms、786.63±151.23,P0.05),聯(lián)律間期也較對照組延長(541.37±111.49ms、497.01±78.75,P0.05),但兩者比值較對照組較小(0.63±0.14、0.65±0.11,P0.05);(3)觀察組中短聯(lián)律間期(≤430ms)發(fā)生率較對照組稍低(13.06%、18.68%,P0.05);(4)觀察組中長短周期現(xiàn)象(≥735ms)發(fā)生率明顯高于對照組(70.00%、60.68%,P0.05);(5)觀察組中由長短周期現(xiàn)象觸發(fā)快速室性心律失常病例發(fā)生連綴現(xiàn)象較無長短周現(xiàn)象者發(fā)生率更高(58.33%、21.43%,P0.05);(6)兩組合并房顫病例數(shù)具有統(tǒng)計學(xué)差異(20.00%、4.08%,P0.05),其中以觀察組發(fā)生例數(shù)較多,包括房顫者10例,其中包括9例形成長短周期現(xiàn)象并觸發(fā)快速性室性心律失常52陣,另外1例在房顫終止2小時后出現(xiàn)反復(fù)室顫形成心電風(fēng)暴。結(jié)論:室早是臨床上發(fā)生快速性室性心律失常(室性心動過速、心室撲動、心室顫動)的常見觸發(fā)因素,尤其合并長短周期現(xiàn)象者觸發(fā)風(fēng)險更高,且長短周期現(xiàn)象中長心動周期延長越明顯,其觸發(fā)幾率越高,同時長短周期現(xiàn)象還具有觸發(fā)快速性室性心律失常反復(fù)或持續(xù)發(fā)作形成連綴現(xiàn)象,從而誘發(fā)惡性室性心律失常的風(fēng)險。房顫因其具有心律絕對不整的特點(diǎn),可以自然形成長短周期現(xiàn)象而觸發(fā)快速性室性心律失常,提示房顫可能亦具有觸發(fā)惡性室性心律失常的風(fēng)險。
[Abstract]:Objective: to analyze the common inducing factors of ambulatory electrocardiogram in the diagnosis of tachyarrhythmia, and to measure the early RR interval, synhythmic interval and the ratio of them. To compare and analyze the characteristics of ventricular premature triggered by tachyarrhythmia, and to explore the correlation between the occurrence of premature ventricular arrhythmias and the occurrence of tachyarrhythmias, and the relationship between the spontaneous formation of long-cycle of ventricular premature arrhythmias or atrial fibrillation and the occurrence of tachyarrhythmias. In order to understand the trigger and maintenance mechanism of tachyarrhythmia, and provide more objective reference index for clinical evaluation of risk classification of ventricular arrhythmia, Methods: 50 cases of tachyarrhythmia diagnosed by dynamic electrocardiogram were collected as observation group. In addition, 49 cases of single ventricular premature ventricular arrhythmias diagnosed by ambulatory electrocardiogram (DECG) were selected as the control group, and the data of the two groups were compared and analyzed. The common trigger factors of tachyarrhythmia were statistically analyzed, and the preRR interval, synhythmic interval and ratio between the two groups were measured, and the statistical differences between the two groups were compared. In order to evaluate the correlation of long-period phenomenon to trigger tachyarrhythmia, the observation group was divided into two groups: the group of continuous phenomenon and the group of non-continuous phenomenon. Statistical analysis was made on whether tachyarrhythmias triggered by premature ventricular arrhythmias were more likely to occur contiguous phenomenon, and electrocardiogram characteristics were analyzed before and after the occurrence of tachyarrhythmias. Results: a comparative analysis of two groups of dynamic electrocardiogram data showed that a total of 531 tachyarrhythmias occurred in 50 cases in the observation group. The anterior RR interval in the observation group was significantly longer than that in the control group (909.73 283.22ms / min 786.63 鹵151.23mg / kg P0.05N), and the combined rhythm interval was also prolonged (541.37 鹵111.49ms) 497.01 鹵78.75mg / min, but the ratio of the two was 0.63 鹵0.140.65 鹵0.11P0.05P0.03s (鈮，

本文編號：1654924