食管信號平均竇房結(jié)電圖在部隊傷病員中的應(yīng)用

摘要： 探討無創(chuàng)性經(jīng)食管信號平均直接記錄竇房結(jié)電圖(SNE)的技術(shù)。在8只犬進行了系列實驗研究的基礎(chǔ)上,又對1289例食管電生理檢查竇房結(jié)傳導(dǎo)時間(SACT)和竇房結(jié)恢復(fù)時間(SNRT)均在正常范圍的部隊傷病員,男968例、女321例,年齡47.6±12.6(10-86)歲進行檢測,其中256例進行了心內(nèi)有創(chuàng)SNE的記錄。采用自制三導(dǎo)心電微電位檢測儀將食管導(dǎo)聯(lián)的信號放大(增益達到100uV/cm)、濾波(0.1-50Hz),16位模/數(shù)(A/D)轉(zhuǎn)換,系統(tǒng)采樣頻率2 kHz,對信號進行疊加,1 1 08例(86%)記錄到食管SNE。所測信號平均食管SNE為P波前的低幅、低頻波,可見有兩種形態(tài):園頂型(62%)和上斜型(38%)。所測竇房傳導(dǎo)時間為83.6±26.5 ms,與有創(chuàng)心導(dǎo)管記錄的竇房結(jié)傳導(dǎo)時間(80.4±18.1 ms)相一致,分布范圍為23—1 18ms;波幅為3.5—27.7uV;dv/dt為0.43—1.93mV/s。結(jié)論為在適當(dāng)?shù)臑V波、高增益和抗基線漂移技術(shù)條件下,利用經(jīng)食管信號疊加技術(shù),大多數(shù)竇房結(jié)功能正常的患者可直接記錄到食管SNE。
Develop a noninvasive transesophageal signal averaging technique for direct recording of sinus node electrogram.1289 Military patients were recorded.968 were male and 321 were female,aged from 47.6±12.6(10～86) year.The signals from lead I,surface averaged lead and esophagus averaged lead were amplified(up to 100μV/cm), filtered(0.1~50Hz),AD converted to 16-bit accuracy at a sampling rate of 2kHz and averaged by using the three-channel low-noise amplifier.In order to verify the reality of sinus node potentials recorded by esophageal lead,electric activities of esophagus/sinus node area and right atrium are simultaneously recorded by intracardiac direct record method in man and in dog.Sinus node electrograms were recorded from 1108 of 1289 patients(86%).The signal averaged esophageal sinus node potentials were deflections of low-amplitude and low-frequency preceding the P wave.Two morphologies, the domed wave(687 of 1108 patients,62%) and the smooth upstroke slope(421 of 1108 patients,38%),can be seen. The directly recorded sinoatrial conduction time was 83.6±26.5 ms(mean±2SD),ranged from 23 to 118ms,amplitude was 3.5～27.7μV and dv/dt was 0.43～1.93mV/s.The sinoatrial conduction time recorded by the transesophageal catheter technique was comparable to that(80.4±18.1ms) recorded by the transvenous catheter method perfectly. Signal averaged sinus node electrogram could recorded in sinus rhythm in most patients with normal sinus node function and proper filter settings,high amplification and anti-drift technique are important in recording signal averaged esophageal sinus node electrogram.