食管信号平均窦房结电图在部队伤病员中的应用 - 中国数字医学.PDFVIP

数字医学研究与应用 Research and Application of Digital Medicine 食管信号平均窦房结电图在 部队伤病员中的应用 丁世芳① 郭赤② 马大波① 卢青① 王仁学① 摘 要 探讨无创性经食管信号平均直接记录窦房结电图（SNE）的技术。在8只犬进行了系列实验研究的基础上，又对 1289例食管电生理检查窦房结传导时间（SACT）和窦房结恢复时间（SNRT）均在正常范围的部队伤病员，男968例、女 321例，年龄47.6±12.6 (10-86)岁进行检测，其中256例进行了心内有创SNE的记录。采用自制三导心电微电位检测仪将 食管导联的信号放大（增益达到100uV/cm）、滤波（0.1-50Hz），16位模/数（A/D）转换，系统采样频率2 kHz ，对信号 进行叠加，1108例（86%）记录到食管SNE。所测信号平均食管SNE为P波前的低幅、低频波，可见有两种形态：园顶型 （62%）和上斜型（38%）。所测窦房传导时间为83.6±26.5 ms，与有创心导管记录的窦房结传导时间（80.4±18.1 ms） 相一致，分布范围为23—118ms；波幅为3.5—27.7uV；dv/dt为0.43—1.93mV/s。结论为在适当的滤波、高增益和抗基线漂 移技术条件下，利用经食管信号叠加技术，大多数窦房结功能正常的患者可直接记录到食管SNE。 关键词 电生理学 窦房结电图 信号叠加 食管导管 Doi:10.3969/j.issn.1673-7571.2010.011.031 Experimental and Clinical Study of Sinus Node Electrogram by Transesophageal Signal Averaging Technique in Military Patients / DING Shi-fang, GUO Chi, MA Da-bo, et al//China Digital Medicine.-2010 5(11): 98 to 101 Abstract 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