慢型克山病猝死前的心电图分析

　　目的　

　　分析研究慢型克山病猝死前的心电图变化,为克山病防治研究提供有价值的资料。方法　应用心电图检查现存的慢型克山病,然后追踪观察慢型克山病猝死前的心电图表现。

　　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 . 0 73ms ,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 .0 3mm·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 2 0 0 2 - 2 0 0 4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1 1　检查对象在 2 0 0 2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。

　　Objective To study the changes of electrocardiogram (ECG) prior to sudden death patient with chronic Keshan disease(CKD). Methods ECG of patient with CKD was recorded and displayed of ECG about prior to sudden death patient with CKD was continuously observed. Results The CKD mean value of QRS complex interval of prior to sudden death patient with was 0.17 ms, and the mean value of ventricular activation time (VAT) on v 5 lead was 0.073 ms. There were ventricular premature beat (VPB) on all of sudden death patient with CKD. There was abnormal STT on all of 8 sudden death patient with CKD. There were respective 5 cases of VPB accompanied left ventricular hypertrophy (LAH) and left atria hypertrophy(LAH). 4 cases of VPB were accompanied with left anterior fascicule block(LAB), and 3 VPB cases had complete right bundle branch block (CRBBB) and complete left bundle branch block (CLBBB) with first-degree atrioventricular block(Ⅰ ° AVB). There were 2 cases of VPB accompanied right ventricular hypertrophy(RVH). There were respective 1 case of VPB accompanied transient ventricular tachycardia,left posterior fascicular block (LPB), pre-excitation syndrome and atria extra systole. There were abnormal ST-T on all of 8 cases. There were respective 5 cases of p wave terminal force on v1 lead(Ptf-v 1)<0.03 mm·s and Q-T interval prolongation. There were 4 cases of Tv 1>Tv 5 syndrome, 2 cases of abnormal Q wave and 2 cases of QRS complex low voltage tendency. Conclusion On ECG, the main changes of sudden death patient with CKD are VPB, obviously extended interval of QRS complex and VAT on v 5 lead, large negative value of Ptf-v 1, CRBBB, LAB, Ⅰ ° AVB, CLBBB, abnormal ST-T, extended Q-T interval, Tv 1>Tv 5, abnormal Q wave and QRS complex low voltage tendency.