特发性室性期前收缩患儿心率变异性和心率减速力的研究

摘要

Objective To explore the relationship between heart rate variability (HRV) and deceleration capacity (DC) in children with idiopathic ventricular premature contraction of different origins. Methods The clinical data from 155 children with idiopathic ventricular premature contraction were retrospectively analyzed. According to the age, the children were divided into young children group (< 3 years old), preschool age group (3-6 years old) and school age group (6-16 years old). Each group was divided into the right ventricular type group and the left ventricular type group respectively according to the origin site. The differences of HRV and DC were compared among groups. Results Among three different age groups, the DC and time domain of HRV were signiifcantly different (P all < 0 . 05 ). In young children group, RMSSD, HF, LF/HF, DC, and PNN 50 were statistically different between right ventricular type group and left ventricular type group (P all < 0 . 05 ). In preschool age group, RMSSD, LF, HF, LF/HF, and DC were statistically different between right ventricular type group and left ventricular type group (P all < 0 . 05 ). In school age group, the RMSSD, HF, LF/HF, and DC were statistically different between right ventricular type group and left ventricular type group (P all < 0 . 05 ). Conclusions Children with idiopathic ventricular premature contraction have impaired regulations of cardiac autonomic system which mainly manifests as reduced tension of vagus nerve. Ventricular premature contraction originated from ventricle preponderance (young children and preschool children are right preponderance while school children are left preponderance) increases the risk of malignant arrhythmia.%目的：探讨不同起源特发性室性期前收缩患儿的心率变异性（HRV）与心率减速力（DC）各项指标的关联性。方法回顾性分析155例特发性室性期前收缩患儿的临床资料，按不同年龄组分为婴幼儿期（< 3岁），学龄前期组（3 ~ 6岁）和学龄期（~ 16岁），并在不同年龄组内按室性期前收缩来源部位不同，分为右室型组和左室型组；比较分析不同年龄组、不同来源期前收缩组之间HRV与DC各指标的差异。结果三个不同年龄组的DC和HRV时域分析各项参数的差异均有统计学意义（P < 0.05）。婴幼儿组中，右室型组和左室型组间相邻RR间期差值的均方根（RMSSD）、高频功率（HF）、低频功率（LF）/HF、DC、相邻RR间期差值50 ms的百分数（PNN 50）差异均有统计学意义（P均 < 0.05）；学龄前期组中，右室型组和左室型组间的RMSSD、LF、HF、LF/HF、DC差异有统计学意义（P均 < 0.05），学龄期组中，右室型组和左室型组间的RMSSD、HF、LF/HF、DC差异均有统计学意义（P均 < 0.05）。结论特发性室性期前收缩患儿自主神经平衡调节受损，以迷走神经张力的降低为主；起源于优势心室（婴幼儿期及学龄前期患儿以右心室占优势，学龄期患儿左心室为优势心室）的频发室性期前收缩，增加了恶性心律失常发生的风险。