倍他乐克干预儿童频发室性早搏的临床价值探讨

发布时间：2018-04-01 10:37

本文选题：儿童　切入点：频发室性早搏　出处：《重庆医科大学》2014年硕士论文

【摘要】：目的：利用倍他乐克对不同类型儿童频发室性早搏的作用，探讨倍他乐克干预儿童频发室性早搏的临床价值。方法：收集2012年1月-2014年3月重庆医科大学附属儿童医院就诊的频发室性早搏（Premature Ventricular Contractions，PVCs）患儿21例,分组方法有两种,一是依据体表心电图上QRS的形态确定PVCs的起源位置并分为左室型及右室型两组;二是依据PVCs出现的时间规律，将所有患儿分为混合型、夜间型及日间型。所有病例给予倍他乐克1-2mg/（kg·d），2次/天，连续口服2周，无效病例停药，有效病例继续使用3个月，并逐渐减量至停药。治疗前后随访动态心电图、心脏彩超，比较各组之间治疗效果差异及治疗前后心率变异性（Heart RateVariability，HRV）时域指标的差别。结果： 1．PVCs与心率(Heart Rate，HR)之间的关系：正相关组（PVCs hadPositive Correlation with HR，P-PVCs）：PVCs随HR的增加而增加，减少而减少，呈现同增共减的关系；共11例，其中男7例，女4例，年龄7.72±2.17岁。负相关组（PVCs had Negative Correlation with HR，N-PVCs）：PVCs随HR的增加而减少，减少而增加；共5例，其中男3例，女2例，年龄6.48±3.63岁。独立组（PVCs were Independentwith HR，I-PVCs）：PVCs与HR的增加或减少无明显线性相关性；共5例，其中男4例，女1例，年龄4.48±1.38岁。 2. PVCs与自主神经系统（Autonomic Nervous System，ANS）的关系：经Pearson相关性检验，15例（71.4%）患儿与SDNN相关。其中12例与RMSSD成正相关，3例与RMSSD成负相关。有11例与PNN50成正相关，7例与PNN50成负相关。在N-PVCs中5例（100%）全部与PNN50成正相关，在P-PVCs中3例（27.3%）与PNN50成正相关，有6例（54.5%）与PNN50成负相关。P-PVCs、N-PVCs和I-PVCs3组之间在性别、年龄、是否合并心肌炎、PVCs起源位置、平均HR及24小时PVCs次数占总心搏的百分比分布均无显著差异，，在昼夜规律上有显著差异。其中8例日间型病例全部分布在P-PVCs，在P-PVCs组中占72.7%，而N-PVCs组中有1例夜间型，其余均为混合型，在I-PVCs组中则5例均为混合型。HRV各时域指标SDNN、SDNNI、SDANN、PNN50、RMSSD在3组之间无显著差异；在P-PVCs组与交感神经活性有关HRV时域指标SDANN(124.36±55.08ms)大于N-PVCs组的(123.00±44.72ms)，而在N-PVCs组与迷走神经活动有关的HRV时域作指标RMSSD（166.20±42.65ms）大于P-VPCs组的（113.73±51.03ms）。 3.倍他乐克对与HR呈不同关系的PVCs的作用：根据PVCs与HR关系的分组的分析，11例患儿的P-PVCs组有9例为有效，2例无效，有效率81.8%；5例患儿的N-PVCs组和I-PVCs组，均为2例有效，3例无效，有效率40.0%。P-PVCs组的有效率高于N-PVCs组和I-PVCs组。 4.倍他乐克对不同起源位置PVCs的作用：根据PVCs的起源位置分析，21例病例中起源于左室者13例，起源于右室者8例，两组间在年龄、性别、是否合并器质性心脏病、平均HR、PVCs占总心搏的百分比、及PVCs昼夜规律均无显著差异。使用倍他乐克后，右室起源的PVCs患儿中6例有效（75.0%）高于左室起源的PVCs（7例有效，53.8%）。 5.倍他乐克对不同昼夜规律PVCs的作用：根据PVCs出现的昼夜时间规律分析，21例病例中有8例日间型，12例混合型和1例夜间型。混合型与日间型在年龄、性别、病因、24小时平均HR、PVCs占总心搏的百分比及PVCs起源部位，两组间分布均无显著差异。日间型中有7例有效（87.5%），对倍他乐克的敏感性高于混合型（5例有效，41.7%）。 6.治疗前后心率变异性（Heat Rate Variability, HRV）各时域参数的变化情况：使用倍他乐克治疗后随访动态心电图HRV时域参数的变化情况，SDNN较治疗前稍有升高，SDANN较用药前降低，RMSSD较用药前有升高，但3者在治疗前后均无显著差异。 7．PVCs在随访时间内的变化情况：本组21例患儿中，有13例对倍他乐克的治疗有效，在用药第2或第4周室24小时动态心电图提示室早次数较用药前减少"g50%，但是随着倍他乐克的减量及停药，除外确诊为心肌炎的2例病例外，其余患儿在随访至3月或更长时间后，PVCs呈现逐渐增加趋势，部分恢复到用药前水平甚至超过了用药前的水平。结论： 1.对于体表心电图上不同起源位置的频发PVCs，倍他乐克对右室型的抑制作用优于左室型。 2.对不同昼夜规律的PVCs，倍他乐克对日间型疗效优于混合型。 3.倍他乐克对不同的儿童频发PVCs作用不同。对无明显器质性病变与自主神经功能相关的PVCs停药后易复发，可能需随访较长时间至自主神经功能发育的完善才可能消失；对于与心肌炎有关的自主神经功能损伤或失衡所致的PVCs疗效较好，停药后不易复发。
[Abstract]:Purpose :

To investigate the effect of betaloc on the ventricular premature beat of children with different types of children , and to discuss the clinical value of betaxlek ' s intervention in children ' s frequent ventricular premature beats .

Method :

Methods Twenty - one cases of premature ventricular premature beat ( PVCs ) were collected from January 2012 to March 2014 in Chongqing Medical University Affiliated to Chongqing Medical University . One was divided into two groups : left ventricular type and right ventricular type according to QRS morphology on body surface electrocardiogram . All cases were divided into mixed type , night type and daytime type . All cases were given betaxle1 - 2mg / ( kg 路 d ) , 2 times / day , continuous oral 2 weeks , ineffective case discontinuation , effective cases continued to be used for 3 months , and gradually decreased to discontinuation . After treatment , the dynamic electrocardiogram and heart color Doppler ultrasound were used to compare the difference of treatment effect between groups and the difference of time domain indexes of heart rate variability ( HRV ) before and after treatment .

Results :

1 . The relationship between PVCs and heart rate ( HR ) : PVCs hadpositive correlation with HR , P - PVCs : PVCs increased with the increase of HR , decreased and decreased with increasing HR .
There were 11 cases , including 7 males and 4 females , age 7.72 卤 2.17 years . The negative correlation group ( PVCs had Negative Correlation with HR , N - PVCs ) : PVCs decreased with the increase of HR , decreased and increased ;
There were 5 males and 2 females , age 6.48 卤 3.63 years old . PVCs were independent with HR , I - PVCs : PVCs had no obvious linear correlation with the increase or decrease of HR ;
There were 5 males , 4 females , 1 female , 4.48 卤 1.38 years old .

2 . The relationship between PVCs and autonomic nervous system ( ANS ) was studied by Pearson correlation . Among them , 15 cases ( 71.4 % ) had positive correlation with PNN50 . Among them , 12 cases were positively correlated with PNN50 . There were 11 cases of P - PVCs positive correlation with PNN50 . There were 6 cases ( 54.5 % ) in the P - PVCs group .
In the P - PVCs group , the HRV time - domain indexes SDANN ( 124.36 卤 55.08 ms ) were greater than that of the N - PVCs group ( 123.00 卤 44.72ms ) , while the HRV time - domain index RMSSD ( 166.20 卤 42.65ms ) in the N - PVCs group and the vagus nerve activity was larger than that in the P - VPCs group ( 11.73 卤 51.03ms ) .

3 . The effect of betaloc on PVCs with HR was : According to the analysis of the relationship between PVCs and HR , 9 out of 11 children with P - PVCs were effective , 2 were ineffective and the effective rate was 81.8 % ;
The efficiency of the P - PVCs group was higher than that of the group I - PVCs and the group I - PVCs .

4 . The effect of betaxlek on PVCs in different origins : According to the origin position analysis of PVCs , 13 cases originated from the left ventricle in 21 cases , 8 cases originated from right ventricle , 8 cases were originated from right ventricle , 6 of PVCs in right ventricular origin were more effective ( 75.0 % ) than PVCs in the left ventricle ( 7 cases were effective , 53.8 % ) .

5 . The effect of betaloc on PVCs of different day and night was analyzed . According to the day and night time rule of PVCs , 8 of 21 cases were daytime type , 12 mixed type and 1 night type . The average HR , PVCs and PVCs were not significantly different between the two groups . There were 7 cases ( 87.5 % ) in daytime type , and the sensitivity to betaxlek was higher than that of mixed type ( 5 cases , 41.7 % ) .

6 . Changes of time domain parameters of heart rate variability ( HRV ) before and after treatment : The changes of HRV time domain parameters were observed after treatment with betaloc , SDNN was slightly increased before treatment , SDANN was lower before treatment , and the RMSSD increased before the treatment , but no significant difference was found between the 3 patients before and after treatment .

7 . The changes of PVCs during follow - up time : 13 of the 21 children in this group were effective in the treatment of betaloc , and the dynamic electrocardiogram suggested that the number of premature beats decreased " g50 % before administration , but with the dose reduction and withdrawal of betaloc , except for 2 cases diagnosed as myocarditis , the rest of the children showed a progressive increase in PVCs after the follow - up to March or longer , and the level of partial recovery to the pre - medication level was even more than the pre - medication level .

Conclusion :

1 . The inhibitory effect of betaxlek on the right ventricular type was superior to that of the left ventricular type for the frequency of PVCs with different origins in the body surface electrocardiogram .

2 . PVCs with different day and night laws and betaloc were superior to those of mixed type .

3 . The effect of Betaloc on different children ' s frequency of PVCs was different . There were no obvious organic lesions after withdrawal of PVCs related to autonomic nervous function . It may be necessary to follow up for a long time until the development of autonomic nervous function is complete .
The effect of PVCs due to the injury or imbalance of the autonomic nervous function associated with myocarditis is good , and it is not easy to recur after discontinuation .

【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.4

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