慢型克山病猝死前的心电图分析

结果

猝死前慢型克山病在心电图上qrs波时间的均值为0.17ms、v5的vat时间的均值为0.073ms,猝死的病人均有vpb,合并左心室大劳损、左房大的各有5例,合并lab的有4例,合并crbbb、clbbb、ⅰ度avb各有3例,合并右室大劳损的有2例,合并lpb、短阵室速、预激综合征、房性早搏的各1例。8例均有st-t的异常,ptf-v1<-0.03mm·s、q-t间期延长各有5例,tv1>tv5有4例,q波异常有2例,qrs波有低电压倾向的2例。结论导致慢型克山病猝死的主要心电图改变是vpb、qrs波和v5的vat时间明显延长、ptf-v1负值增大、crbbb、lab、ⅰ度avb、clbbb、st-t异常、q-t间期延长、tv1>tv5、q波异常和qrs波的低电压倾向。

据对死亡克山病病例中的调查,亚急型、慢型、潜在型的克山病均可发生猝死,尤其是慢型克山病猝死率最高〔1〕。为了解慢型克山病猝死前的心电图变化,从而为克山病的防治研究提供有价值的资料,我们于2002-2004年对部分慢型克山病的病人进行心电图追踪观察,以观察猝死前慢型克山病病人的心电图表现。现将结果报告如下。1资料和方法11检查对象在2002年深入我省克山病发病重病区的平邑、沂水、邹诚、五连、莒县、泗水等县的克山病病户中,应用心电图对现存的慢型克山病病人进行了检查,共检查慢型克山病病人76例。

objectivetostudythechangesofelectrocardiogram(ecg)priortosuddendeathpatientwithchronickeshandisease(ckd).methodsecgofpatientwithckdwasrecordedanddisplayedofecgaboutpriortosuddendeathpatientwithckdwascontinuouslyobserved.resultstheckdmeanvalueofqrscomplexintervalofpriortosuddendeathpatientwithwas0.17ms,andthemeanvalueofventricularactivationtime(vat)onv5leadwas0.073ms.therewereventricularprematurebeat(vpb)onallofsuddendeathpatientwithckd.therewasabnormalsttonallof8suddendeathpatientwithckd.therewererespective5casesofvpbaccompaniedleftventricularhypertrophy(lah)andleftatriahypertrophy(lah).4casesofvpbwereaccompaniedwithleftanteriorfasciculeblock(lab),and3vpbcaseshadcompleterightbundlebranchblock(crbbb)andcompleteleftbundlebranchblock(clbbb)withfirst-degreeatrioventricularblock(ⅰ°avb).therewere2casesofvpbaccompaniedrightventricularhypertrophy(rvh).therewererespective1caseofvpbaccompaniedtransientventriculartachycardia,leftposteriorfascicularblock(lpb),pre-excitationsyndromeandatriaextrasystole.therewereabnormalst-tonallof8cases.therewererespective5casesofpwaveterminalforceonv1lead(ptf-v1)<0.03mm·sandq-tintervalprolongation.therewere4casesoftv1>tv5syndrome,2casesofabnormalqwaveand2casesofqrscomplexlowvoltagetendency.conclusiononecg,themainchangesofsuddendeathpatientwithckdarevpb,obviouslyextendedintervalofqrscomplexandvatonv5lead,largenegativevalueofptf-v1,crbbb,lab,ⅰ°avb,clbbb,abnormalst-t,extendedq-tinterval,tv1>tv5,abnormalqwaveandqrscomplexlowvoltagetendency.

（责任编辑：jbwq）