目的:分析儿童动态心电图不同时段参数与心率变异性的相关性.方法:采用回顾性及前瞻性方法,选取678例患儿的临床资料,将其作为观察组,并根据年龄分成六组,比较分析每一组心率变异性时域指标.同时选取我院体检的678例健康儿童作为对照组.比较两组心率变异性时域指标,并且分析不同年龄以及不同检测时间心率变异性时域指标(SDNN、rMSSD、PNN50)差异及与其相关性.结果:观察组SDNN、rMSSD、PNN50水平均高于对照组,其差异有统计学意义(P<0.05).随着年龄的增长,SDNN、rMSSD、PNN50均降低趋势,差异具有统计学意义(P<0.05);经过秩相关性分析显示年龄与心率变异性的时域指标间呈现明显的负相关关系(rs=-0.453\-0.785\-0.521,P<0.05);不同的检测动态心电图监测时间,SDNN、rMSSD、PNN50差异具有统计学意义(P<0.05),且随着检测时间延长SDNN、rMSSD、PNN50均有下降趋势,经过秩相关分析显示不同检测时段与心率变异性的时域指标间呈现负相关关系(rs=-0.255\-0.368\-0.416,P<0.05).结论:各个年龄段患儿的心率变异性指标均低于健康儿童,且患儿年龄越小,心率变异性越明显,并且在动态心电图监测开始4h以内心率变异性最为明显,可为临床心血管疾病的诊断提供参考依据.

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在小儿心神经症诊断中的应用价值.方法:对600例有症状的对象同时作十二导联心电图及高频心电图.结果:600例中210例正常,占35.0%,异常251例,占41.8%,可疑139例,占23.1%.结论:高频心电图检查结果正常对小儿心神经症有辅助诊断的作用.