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目的 探讨老年病态窦房结综合征 (SSS)临床特征。方法 对 5 0例老年SSS发病年龄、病因、病程、症状和动态心电图 (DCG)进行回顾分析。结果 70岁以后男性SSS发病率明显上升 ,病因依次是冠心病 ,特发性SSS ,高血压性心脏病 ,老年退行性心脏瓣膜病以及心肌病。老年SSS平均病程长约 10年 ,且与DCG分型有关 ,III型的最长 ,IV型的最短 ,I型与II型相近。早期DCG多为阵发性房颤 ,阵发性室上性心动过速 ,频发房早 ,窦房阻滞 ,房室传导阻滞和束支传导阻滞 ,以后逐渐演变成四种类型的SSS。症状晚于心律失常出现 ,早期为心悸、头昏和乏力 ,晚期为黑朦 ,晕厥及心绞痛和心衰加重。起搏器安置时机取决于临床症状而不是DCG分型。结论 SSS多发于 70岁以上男性 ,多种病因 ,起病隐匿 ,病程漫长。早期心电图和症状不典型 ,晚期DCG可分成四种类型 ,晚期症状黑朦和晕厥等 ,症状严重程度决定起搏器安置时机。连续DCG检测是评估老年窦房结功能常用的有效的方法。
Objective To investigate the clinical features of senile sick sinus syndrome (SSS). Methods The age, etiology, course of disease, symptoms and ambulatory electrocardiogram (ECG) of 50 senile patients were retrospectively analyzed. Results The incidence of SSS in men after 70 years of age was significantly increased, followed by coronary heart disease, idiopathic SSS, hypertensive heart disease, senile degenerative valvular heart disease and cardiomyopathy. The average duration of SSS in elderly patients is about 10 years, and is related to the classification of DCG. The type III is the longest, the type IV is the shortest, and the type I and type II are similar. Early DCG mostly paroxysmal atrial fibrillation, paroxysmal supraventricular tachycardia, frequent atrial fibrillation, sinoatrial block, atrioventricular block and bundle branch block, gradually evolved into four types of SSS . Symptoms later than arrhythmia, early palpitations, dizziness and fatigue, late for the dark, fainting and angina and heart failure worse. Pacemaker placement timing depends on clinical symptoms rather than DCG typing. Conclusion SSS occurs in men over the age of 70, a variety of etiology, onset of occult, long course. Early ECG and atypical symptoms, advanced DCG can be divided into four types, late symptoms such as dark and fainting, the severity of the symptoms determine the timing of placement of pacemaker. Continuous DCG test is commonly used to evaluate senile sinoatrial node function.