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12-HOLTER监测老年持续性房颤动伴长R-R间期232例分析 李诗贤，赵 娟 【摘要】 目的?探讨老年持续性心房颤动伴长R-R间期特点及临床意义，为临床治疗老年性房颤提供理论依据。方法? 收集门诊及住院老年（60岁以上） HYPERLINK javascript:; \t _self 病人持续性心房颤动者232例，均采用十二导联同步持续24h动态心电图监测，将24h平均心室率≥70bpm的持续性心房颤动患者纳入快心室率组，将24h平均心室率＜70bpm的持续性心房颤动患者纳入慢心室率组，统计白天（或运动）和夜间（或休息）时，1.5s以上的长R-R间期发生时间及频度，将两组病例进行对比研究。结果 232例老年心房颤动患者中，快心室率组71例 HYPERLINK javascript:; \t _self 患者共出现R-R间期≥1.5s 182次，R-R间期≥2.0s 128次；慢心室率组161例 HYPERLINK javascript:; \t _self 患者共出现R-R间期≥1.5s 2595次，R-R间期≥2.0s 8256次。两组统计结果有显著性差异，p＜0.05。结论 由于夜间（或休息）时，迷走神经张力增加，房室结不应期延长，阻止f波下传至心室，因此长R-R间期多发生在夜间（或休息），以慢心室率最为多见。 【关键词】老年持续性； 心房颤动； 长R-R间期 【Abstract】 Objective To discuss the features and clinical significance of elderly persistent?atrial fibrillation associated with long R-R interval so as to provide a theoretical basis for clinical treatment of elderly atrial fibrillation. Methods 232 elderly patients (over 60-s) from outpatients and inpatients with persistent?atrial fibrillation were collected, all of them were monitored with 12-lead Holter. 71 patients whose ventricular rate ≥70bmp were selected as rapid?ventricular?rate group while 161 patients with ventricular rate 70bmp were selected as slow?ventricular?rate group. Count up and compare the time and frequency of long R-R interval that last more than 1.5s during daytime (or exercise) and night (or rest). Results The times of 1.5s more long R-R interval of patients in rapid ventricular rate group appears 182 times while 2s more long R-R interval appears 128 times; the times of 1.5s more long R-R interval of patients in slow ventricular rate group appears 2595 times while 2s more long R-R interval appears 8256 times. There was significant difference between two groups, P0.05. Conclusion The vagal tone?increases during night (or rest), refractory period of atrioventricular node lengthens, the f-wave is been prevented to download to the ventricle so that the long R-R interval occurs mostly in slow ventricular rate patients during night (or rest). ——