患儿女性,现年龄7个月.出生前发现心率慢,出生后心电图检查为三度房室传导阻滞,交界性自主节律,室内传导阻滞,其母患有系统性红斑狼疮;实验室检查患儿抗SSA抗体+++,抗SSA-R052KDa抗体+++等异常,符合母体自身抗体相关性心脏传导阻滞诊断.4次24 h动态心电图大数据时间散点图出现分层分布;Lorenz-RR散点图可呈4、5分布,提示该患儿房室结功能分离(变时不良).

Objective: To investigate the clinical value of ambulatory electrocardiogram and the neutrophils to lymphocytes ratio (NLR) in the diagnosis on Kawasaki disease combined with changes of coronary artery for children. Methods: 80 children with Kawasaki disease were enrolled in the research. According to the combined situation of coronary artery disease, all of children with combined coronary artery disease were divided in observation group (48 cases) and the children without combined coronary artery disease were divided in control group (32 cases). All of children received the examinations of dynamic electrocardiogram, routine electrocardiogram, ultrasound cardiogram scan and blood routine detection within 15d of occurring disease. And the amounts of neutrophil and lymphocyte, and change of dynamic electrocardiogram of all of children were recorded and analyzed. And then the amounts of neutrophil and lymphocyte and the NLR of the two groups were further compared. Results: The sinus tachycardia, atrioventricular block, abnormal average heart rate and the proportions of total abnormal number of observation group were significantly higher than that of control group, and the difference of total number of ambulatory electrocardiographic abnormality between the two groups were significant (x2=20.112, P<0.05). The results of ambulatory electrocardiogram for Kawasaki disease combined with abnormal coronary artery were significantly higher than that of control group (x2=17.778, P<0.05). Compared with control group, the coronary artery ectasia was more larger, the amount of neutrophils would be more greater in observation group, and the difference between the two groups was significant (t=-3.464, P<0.05). Besides, the difference of NLR between patients with mild ectasia of observation group and patients of control group was significantly (t=2.976, P<0.05). Conclusion: Dynamic electrocardiogram and the NLR have important significance in the diagnosis for children with Kawasaki disease combined with the change of coronary artery.

目的 观察病毒性心肌炎患儿治疗前后24小时动态心电图(dynamic electrocardiogram,DCG)改变特点,探讨其临床意义.方法 选择本院2015年2月至2016年12月收治的病毒性心肌炎患儿80例纳入病毒性心肌炎组,将本院同期健康体检儿童80例纳入健康对照组,记录病毒性心肌炎组患儿治疗前后24小时(全程)正常窦性心搏间期的标准差(standard deviation of normal number of intervals,SDNN)、相邻窦性心搏间期差值的均方根(root mean square values of the standard deviation between adjacent normal number of intervals,RMSSD)、24小时窦性心搏间期差值＞50毫秒的个数占总窦性心搏数的百分率(percentage of differences exceeding 50 ms between adjacent normal number of intervals,PNN50)、每5分钟窦性心搏间期平均值标准差(standard deviation of per-5 min averages normal number of intervals,SDANN)、低频(low frequency,LF)、高频(high frequency,HF)及LF/HF比值.结果 病毒性心肌炎组患儿DCG检查中房性期前收缩(28.75％:18.75％,P =0.028)、室性期前收缩(41.25％:32.40％,P＜0.001)、一度房室传导阻滞(18.75％:7.50％,P=0.035)的检出率均显著高于ECG检查.而对病态窦房结综合征、三度房室传导阻滞、Q-T间期延长,ECG并未检出.治疗前病毒性心肌炎组患儿SDNN、SDANN、RMSSD、PNN50、LF、HF均显著低于健康对照组(P＜0.05),LF/HF比值显著高于健康对照组(P＜0.05).治疗后45天,病毒性心肌炎组患儿SDNN、SDANN、RMSSD、PNN50、LF、HF均显著高于治疗前(P＜0.05),LF/HF比值显著低于治疗前(P＜0.05);治疗后45天,病毒性心肌炎组患儿SDNN、SDANN、RMSSD、PNN50、LF、HF及LF/HF比值与健康对照组比较差异均无显著性(P＞0.05).SDNN(OR=2.21)、SDANN(OR=2.53)、RMSSD(OR=2.83)、PNN50 (OR=3.19)、LF (OR=1.87)、HF (OR=3.82)均为病毒性心肌炎心律失常发生的危险因素(P＜0.05),LF/HF比值(OR=0.73)是病毒性心肌炎心律失常发生的保护因素(P＜0.05).结论 DCG在病毒性心肌炎患儿早期心律失常检出方面具有独特的优势,可在一定程度上对疾病治疗及预后判断提供临床数据支持.

目的:探讨高频心电图检查小儿心神经症诊断中应用价值。方法:选取我院收治小儿心神经症患儿218例。均给予高频心电图检查。结果:正常:12导联切迹总数≤8患儿81例(37.15%);可疑:切迹总数在9～11之间患儿7例(3.21%);异常:切迹总数≥12患儿130(59.63%)。结论:高频心电图检查对小儿心神经症正确诊断有重要临床意义。

目的:探讨手足口病患儿心肌酶活性的变化和心电图改变的特点及其临床意义。方法:选择收治的1300例手足口病患儿进行常规心肌酶学检查,同时对1300例患者使用常规的十二导联心电图检查。对心肌酶学检查异常及心电图检查异常的病例数进行统计。观察治疗心肌酶学以及心电图的改变特征及其预后效果。结果:心肌酶学检查异常的患者为1140例(87.7%)。心电图检查异常患者235例(18.1%)其中又以ST-T改变及窦性心动过速为主。大部分的患儿存在激酸激酶的同工酶、CK等心肌酶不同程度升高且心肌损害程度与心肌酶呈正相关。结论:部分手足口病(HFMD)患者可以伴随有心肌的损害,心电图检查和心肌酶监测对手足口病的诊断具有准确方便的特点,并可作为治疗效果和病情观察的有效评价指标。

目的探讨高频心电图(high freguency electrocardiogram,HFECG)对小儿病毒性心肌炎的诊断价值。方法对我院2003年3月~2009年8月确诊的164例小儿病毒性心肌炎,于治疗前后使用ECG-512A心电自动分析仪记录静态卧位心电图和HFECG,回顾性分析检查结果。结果本组治疗前常规心电图(electrocardiogram,ECG)检查正常49例,大致正常46例,异常69例;HFECG检查正常5例,可疑异常31例,异常128例。HFECG阳性率78.05%,显著高于ECG(P<0.01)。治疗2周后复查HFECG正常130例,可疑异常12例,异常19例,切迹数较治疗前显著减少(P<0.01)。结论 HFECG可提高病毒性心肌炎的检出率,动态观察HFECG的切迹数变化,可作为评价疗效的参考指标。

目的探讨晚发性维生素K缺乏症所致颅内出血患儿心电图Q-T间期延长的临床意义。方法对我院1998年7月～2008年7月收治的212例晚发性维生素K缺乏症的临床资料进行分析,了解心电图Q-T间期延长发生率及其与低钙血症、颅内出血的关系。结果212例中49例心电图Q-T间期延长,血钙均降低,头颅CT检查均有颅内出血。经对症治疗痊愈24例,好转18例,死亡5例,放弃治疗2例。结论对晚发性维生素K缺乏症患儿应常规行心电图检查,通过分析Q-T间期而间接了解血钙情况,及早干预,以减少颅内出血和低钙惊厥,改善患儿预后。