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窦性心律：齐或不齐安全吗？

2015-07-24 YoungTsau 医学界心血管微信

窦性心律心电图
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作者：YoungTsau，医学博士，中山大学医学院毕业，美国耶鲁大学博士 正常心脏活动依靠窦房结发出的周期性电脉冲，控制心房和心室有规律的收缩，将血液供应至全身。心脏的电脉冲起源、周期性、节律性、传导时程、传导路径等任何异常，都可能会引起心脏血液动力学变化，影响全身血液供应，严重时可导致生命危险。 通常医生说到窦性心律，都认为是安全的，而对于窦性心律不齐的解读却是语焉不详。事实上，即使是起

作者：YoungTsau，医学博士，中山大学医学院毕业，美国耶鲁大学博士

正常心脏活动依靠窦房结发出的周期性电脉冲，控制心房和心室有规律的收缩，将血液供应至全身。心脏的电脉冲起源、周期性、节律性、传导时程、传导路径等任何异常，都可能会引起心脏血液动力学变化，影响全身血液供应，严重时可导致生命危险。

通常医生说到窦性心律，都认为是安全的，而对于窦性心律不齐的解读却是语焉不详。事实上，即使是起源于窦房结的窦性心律，虽然暂时没有生命安全问题，也可能意味着心脏意外的风险。窦性心律不齐的现象非常普遍，那么，不同的窦性心律不齐是怎样产生的？又如何快速判断？

窦性心律不齐可分为正常生理性和病理性两种，后者有潜在心脏意外风险。生理性的窦性心律不齐与呼吸引起的植物神经的张力放电频率变化有关，常见于青少年和经常运动锻炼者。心电检查表现为心动周期逐渐改变时间长度，好像潮汐那样，并且改变可与呼吸相关。下图为一例运动员的心电检查：


在RR间期散点图上表现为环状分布，同时在放大4倍的心动周期的叠加与平均P-QRS-T群组上看，P波非常稳定（反映窦房结以及心房内的传导功能良好）：


心脏专家们认为，心率随植物神经张力而变化，反映心脏和神经体液控制敏捷，是健康的表现。相比之下，心率如果非常稳定，不能随呼吸和运动而改变，提示心脏不能随时调整血液动力学输出以适应全身需要，因为运动时身体需要更多血液输出，心率不能提高意味着无法满足需要。例如心脏起搏器心率，节律就是固定的，无法根据全身需要随时调整。所以，没有窦性心律不齐也不代表心脏就非常健康。下图为一例56岁男性慢性心衰病人的心电检查：


在RR间期散点图上，RR间期几乎完全一致，没有变化，虽然心动周期的叠加平均P-QRS-T群组看没有异常改变：


病理性的窦性心律不齐与心肌缺血、窦房结或传导细胞功能不良、中枢神经控制异常等疾病状态有关，心电检查表现为每个相邻的心动周期的时间长度改变没有规律，并且随时间有不规则变化，影响全身有效血供。下图为一例21岁男性在读大学生的心电检查：


虽然也是窦性心律，但在RR间期散点图上表现为无规律的分布，同时，在心动周期的叠加平均P-QRS-T群组上可清楚见到P波不稳定游走，提示窦房结或心房内传导功能不良：


窦性心律不齐如果影响到血液动力学输出，就会出现临床异常表现，如胸闷眩晕，甚至出现晕厥，或诱发严重心律失常。病理性的窦性心律不齐及窦性心律僵硬，都会增大心脏意外的风险，需要加强随身心脏监护和健康管理，应用大数据分析能够更加清晰看出疾病发展趋势，其好处在于：保留心脏健康状态的完整记录；有助于健康行为和心脏康复；早期获得心脏意外风险预警；及时发现严重问题及时处理，而不是等到心脏意外发生后再去抢救。

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    2015-08-13 jjjjjjboy1009

    学习了...

    0

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    2015-08-06 hlycom3356

    期待有更多研究

    0

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    2015-07-26 飞翔9899

    受用

    0

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    2015-07-26 paperyu

    #窦性心律#

    0

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    2015-07-25 午夜星河

    区别对待

    0

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    2015-07-24 ndd99

    涨知识了

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　　日本学者的一项研究表明，在长期持续性房颤患者中，依普利酮可显著改善导管射频消融（RFCA）后窦性心律维持。论文于2013年1月21日在线发表于《美国心脏病学杂志》（Am J Cardiol）。 　　此项研究共纳入161例接受RFCA治疗的长期持续性房颤患者；受试者房颤持续时间为1至20年，平均3.4 ± 3.8年。接受和未接受依普利酮治疗的患者分别为5

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