目的：对176例经Holter心电图监护所检出的室性心律失常患者行心率减速力（DC）检测，评价其对心脏猝死的临床预测价值。方法采用美国DMS公司的12导联同步描记Holter心电监护仪，对门诊及病房就诊的受检者进行24～72 h的Holter心电图监护，除常规心律失常及ST段监护指标外，同时检测窦性心率震荡（HRT）及心率变异（HRV）的心搏间RR间期标准差指标（SDNN）。将Holter心电监护直接记录出室性心动过速（VT）者列为观察组，共176例，男93例，女83例，年龄39～92岁，平均53岁；随机选取性别和年龄与观察组相仿的182例为对照组进行对比分析。结果以心率减速力＜4．5 ms为异常和＜2．5 ms为显著异常的标准，两组的心率减速力值异常率分别为50．6％（89/176）和4．4％（8/182），观察组明显高于对照组（χ2＝96．6，P＜0．05）；两组的心率减速力显著异常率分别为33．0％（58/176）和0％（0/182），两组间差异显著（χ2＝75．6，P＜0．05）；室性心动过速患者的心率减速力异常检出率明显高于HRT和HRV检测指标（χ2＝106．4，P＜0．05；χ2＝58．6，P＜0．05）。结论室性心动过速患者的心率减速力测定，有较高的异常检出率。%Objective Through detecting the deceleration capacity of heart rate (DC) and other indicators, so as to evaluate the value of DC in clinical prediction of SCD. Methods The 5612 outpatients and inpatients underwent a 24-72 h Holter ECG,in addition to conventional arrhythmia and ST segment monitoring indicators, simultaneous detection of sinus heart rate turbulence(HRT) index of RR interval standard deviation and heart rate variability in cardiac room(SDNN). The Holter ECG was recorded directly from ventricular tachycardia(VT) as the observation group,among the 148 cases of patients with myocardial infarction,14 patients with dilated cardiomyopathy,9 cases of hypertensive heart disease,idiopathic ventricular tachycardia in 3 cases. Acoording to gender and age they were randomly selected,and divided into observation group (176 cases) and matched controls (182). Results The deceleration capacity of rate <4.5ms anomaly and <2.5ms for significant standard,the deceleration capacity of rate value anomaly rates in two groups were 50.6% (89/176) and 4.4% (8/182) respectively. There was a significant difference between the two groups (χ2=96.6,P<0.05);the abnormal detection rate for the deceleration capacity of rate was 33%(58/176) and 0%(0/182) in two groups respectively,the difference between the two groups was significant (χ2=75.6,P<0.05);the abnormal detedtion rate for VT patients was significantly higher than that of patients with HRT and HRV indexes (χ2=106.4,P<0.05;χ2=58.6,P<0.05). Conclusion DC of VT patient is more effective in detecting clinical prediction of HCD in patients.
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