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目的研究12导动态心电图在先天性长QT综合征(LQTS)动态监测中的作用。方法 LQTS患者和健康对照者各9例,监测动态心电图,动态评价静息和运动中QTc间期和QT离散度(QTcd)的变化以及心律失常发生情况。结果 LQTS组,最大QTc0.60±0.07s,正常对照组,最大QTc0.45±0.03s(p<0.05);平均QTc0.52±0.05s而对照组为0.42±0.02s(p<0.05);QTcd0.17±0.07s而对照组为0.06±0.04s(p<0.05)。LQTS组1例尖端扭转型室速发作,发作前可见T波电交替现象。5例患者监测动态心电图4~9年,QTc间期和QTc离散度没有明显变化。结论 LQTS患者,QTc均明显延长,QTcd明显增加,且不受心率影响;长期监测动态心电图没有发现QTc的逐年变化,病情加重期间动态心电图记录到T波电交替和尖端扭转型室速。动态心电图是LQTS的评估、监测必不可少的无创性手段。
Objective To study the role of 12-lead ambulatory electrocardiogram in dynamic monitoring of congenital long QT syndrome (LQTS). Methods Nine patients with LQTS and healthy controls were enrolled in this study. Holter monitoring was performed to evaluate the changes of QTc interval and QTcd during rest and exercise, and the occurrence of arrhythmia. Results The maximum QTc was 0.60 ± 0.07 s in the LQTS group, and the maximum QTc was 0.45 ± 0.03 s in the control group (p <0.05). The average QTc was 0.52 ± 0.05 s in the LQTS group and 0.42 ± 0.02 s in the control group (p <0.05). QTcd0.17 ± 0.07s vs. 0.06 ± 0.04s in control group (p <0.05). One case of LQTS group had torsades de pointes and the alternating T wave appeared before the attack. 5 patients with ambulatory electrocardiogram monitoring 4 to 9 years, QTc interval and QTc dispersion did not change significantly. Conclusions QTc was significantly prolonged in patients with LQTS, QTcd was significantly increased, and not affected by heart rate; long-term monitoring of ambulatory ECG showed no QTc year-to-year changes, during aggravating episodes of electrocardiogram recorded alternating T wave and torsades de pointes ventricular tachycardia. Holter monitoring is an essential and noninvasive means of assessing LQTS.