摘要
目的探讨快速动眼睡眠相关缓慢性心律失常综合征的诊断学特征与治疗。方法回顾性分析山东省千佛山医院心内科2017年9月14日收治的1例快速动眼睡眠相关缓慢性心律失常综合征患者的临床资料,并复习相关文献。结果24 h动态心电图提示:窦性心动过速;窦性停搏,窦性停搏大于2.0 s的为525次,最长停搏3.13 s;一度、二度Ⅰ型、二度Ⅱ型房室传导阻滞;偶发室上性早搏。窦性心动过速主要发生于白天运动后,窦性停搏及房室传导阻滞主要发生于24∶00~7∶00 am。心脏心率变异性:窦性心搏RR间期的标准差为121 ms,峰值出现在夜间,其24 h最快心率169次/min,无ST-T改变。心肌酶、心脏彩超、胸片未见异常。给予去交感神经兴奋诱因后,患者夜间缓慢性心律失常较前明显好转。结论白天交感神经过度兴奋可能是快速动眼睡眠相关缓慢性心律失常的诱因之一。
Objective To explore the diagnostic features and treatment of rapid eye movement(REM)sleep-related bradyarrhythmia syndrome.Methods The clinical data of the patient with bradyarrhythmia syndrome related to REM sleep admitted to Cardiology Department of Shandong Provincial Qianfoshan Hospital on September 14,2017 were analyzed retrospectively,and the relevant literatures were reviewed.Results The results of 24-hour holter showed sinus tachycardia,sinus arrest(sinus arrest was more than 2.0 s for 525 times,and the longest stop was 3.13 s),first degree,second degreeⅠ,second degreeⅡatrioventricular block and occasional supraventricular premature beat.Sinus tachycardia mainly occured in daytime after movement,sinus arrest and atrioventricular block mainly occured from 24∶00 to 7∶00 am.Heart rate variability showed the standard deviation of RR interval of sinus heart beat was 121 ms,the peak appeared at night,the fastest heart rate was 169 times/min within 24 hours,no ST-T change.No abnormality was found in myocardial enzyme,doppler echocardiography and chest radiograph.After removing the inducement of sympathetic nerve excitation,the patient′s arrhythmia at night was significantly improved.Conclusion The hyperactivity of the sympathetic during the day maybe one of the causes of the bradyarrhythmia related to REM sleep.
作者
林林
李婵
林晶如
徐瑞
Lin Lin;Li Chan;Lin Jingru;Xu Rui(Weifang Medical University,Weifang 261053,China;Department of Cardiology,the First Affiliated Hospital of Shandong First Medical University,Shandong Provincial Qianfoshan Hospital,Jinan 250014,China;Department of Cardiology,Shandong Provincial Third Hospital,Jinan 250031,China)
出处
《中华诊断学电子杂志》
2020年第1期52-56,共5页
Chinese Journal of Diagnostics(Electronic Edition)
基金
山东省重点研发计划项目(2018GSF118009)
济南市科技计划项目(201805060)
关键词
睡眠
快速眼运动
窦性停搏
心脏
自主神经系统
Sleep
rapid eye movement
Sinus arrest
cardiac
Autonomic nervous system
