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目的观察儿童先天性长QT综合征(LQTS)患者进行运动试验时QT间期的变化。方法因QT间期延长而行运动平板试验的患儿共33例入选本研究,按照1993年Schwartz等的LQTS诊断标准的计分分值分为两组:LQTS组:总计分值为4分及以上的患者17例,男13例、女4例,年龄11.6±3.7岁;可疑组:评分为1.5~3.5分的患者16例,男9例、女7例,年龄13.8±4.2岁。另选行运动试验的18例正常儿童作为对照组,男11例、女7例,年龄12.4±3.1岁。记录整个运动试验中和恢复期的心电图,观察QT间期和心率的变化,记录并计算恢复期第1,2,4,6 m in QT间期与运动过程中同心率时QT间期的差值(ΔQT)。结果三组患者在运动中随着心率的增加,QT间期逐渐缩短。运动恢复期,随着心率的减慢,三组的QT间期也逐渐延长,但LQTS组恢复期QT间期却显著短于运动过程中处于同心率时的QT间期。LQTS组在恢复期1,2,4 m in的ΔQT值均显著大于其它两组(P均<0.05)。LQTS组在QT间期与心动周期的关系图上呈现明显的“QT滞后环”。结论儿童LQTS患者运动试验恢复期与运动过程中相比,QT间期的变化明显滞后于心率的变化。
Objective To observe the changes of QT interval during exercise test in children with congenital long QT syndrome (LQTS). Methods Totally 33 children undergoing treadmill exercise due to prolonged QT interval were enrolled in this study. They were divided into two groups according to the score of LQTS diagnostic criteria of Schwartz et al. In 1993: LQTS group: the total score was 4 and The above patients were 17 cases, 13 males and 4 females, aged 11.6 ± 3.7 years; in the suspicious group, there were 16 patients with a score of 1.5 to 3.5, 9 males and 7 females, aged 13.8 ± 4.2 years. Another 18 cases of normal exercise test as a control group, 11 males and 7 females, aged 12.4 ± 3.1 years. The electrocardiogram of the whole exercise test and recovery period was recorded. The changes of QT interval and heart rate were observed. The difference of QT interval between 1, 2, 4, 6 m in QT recovery period and concentricity during exercise was recorded and calculated Value (ΔQT). Results Three groups of patients with exercise in the heart rate increases, QT interval gradually shortened. During the exercise recovery period, the QT interval of the three groups gradually increased as the heart rate slowed down. However, the QT interval of the LQTS recovery period was significantly shorter than that of the QT interval during the exercise. The values of ΔQT at 1, 2, and 4 m in LQTS group were significantly higher than those in the other two groups (all P <0.05). The LQTS group showed a significant “QT hysteresis loop” on the QT-to-cardiac cycle diagram. Conclusions The recovery of QT interval in children with LQTS during exercise recovery is significantly slower than that in exercise during exercise test.