胥家永+任国成+高志广+许长存

[摘要] 目的 探讨不同负荷的非器质性室性早搏昼夜节律变化对左心功能的影响。 方法 选取103例非器质性室性早搏患者，根据不同负荷分为三组，即低负荷组（<10%）、中负荷组（10%～20%）、高负荷组（>20%）。根据动态心电图时间分为日间组和夜间组：日间组：日间早搏占全日早搏的50%以上；夜间组：夜间早搏占全日早搏的50%以上。比较左房内径、室间隔厚度、左室舒张末内径、左室后壁厚度、左室射血分数等心功能指标。 结果 不同负荷组非器质性室性早搏比较，左房内径、室间隔厚度、左室舒张末内径、左室后壁厚度差异无统计学意义（P>0.05）。低负荷组与高负荷组比较，左室射血分数差异具有统计学意义（P<0.05）。日间组的室性早搏与夜间组的室性早搏相比，各项心功能指标比较差异均无统计学意义（P>0.05）。 结论 高负荷的非器质性室性早搏更易导致左心射血分数的下降。非器质性室性早搏呈昼夜节律变化，但日间组和夜间组的室性早搏对左心功能影响不大。

[关键词] 室性早搏；昼夜节律；心功能；自主神经

[中图分类号] R541.7 [文献标识码] A [文章编号] 1673-9701（2017）07-0029-04

[Abstract] Objective To investigate the effects of circadian rhythm changes of non-organic ventricular premature beats with different loads on left ventricular function. Methods 103 patients with non-organic ventricular premature beats were selected. The patients were divided into three groups including low load group（<10%）， medium load group（10%-20%） and high load group（>20%） according to different load. The patients were divided into the day group and night group according to the dynamic ECG time. Daytime premature beats accounted for more than 50% of the full day premature beats in the day group. Nocturnal premature beats accounted for more than 50% of the full day premature beats in the night group. The cardiac function indicators including left ventricular diameter， ventricular septum， left ventricular end diastolic diameter， left ventricular posterior wall and left ventricular ejection fraction were compared. Results Different load non-organic ventricular premature beats were compared， and there was no significant difference in left atrial diameter， interventricular septum thickness， left ventricular end-diastolic diameter and left ventricular posterior wall thickness（P>0.05）. There was significant difference in left ventricular ejection fraction between low load group and high load group（P<0.05）. There was no significant difference in indexes of cardiac function between the day group and night group（P>0.05）. Conclusion High-load non-organic ventricular premature beats are more likely to lead to the decrease of left ventricular ejection fraction. The changes of non-organic ventricular premature beats show a circadian rhythm. But ventricular premature beats between the day group and the night group have little effect on left ventricular function.

[Key words] Ventricular premature beats； Circadian rhythm； Heart function； Autonomic nerve

室性早搏是臨床上常见的心律失常。既往传统观念认为非器质性室性早搏患者预后良好[1]，对左心功能影响不大，无需特殊治疗。近些年却发现频发的非器质性室性早搏可引起左室扩大，心功能下降，甚至造成心动过速性心肌病[2]。频发的非器质性室性早搏主要以白天为主，室性早搏数较多，但也有以夜间室性早搏占多数的患者。本文通过比较不同负荷的非器质性室性早搏昼夜节律对左心功能的影响，从而为非器质性室性早搏的治疗提供依据。 ……