CAJ | 학술논문

目的探讨无创性经食管信号平均技术直接记录窦房结电位(SNP)的方法.方法采用自制三导心电微电位检测仪对256例窦房结功能正常者进行检测,其中男142例,女114例,年龄10～74(44.2±12.4)岁.将食管导联的信号放大(增益达到100μV/cm)、滤波(0.1～50)Hz,16位模/数(A/D)转换,系统采样频率2 kHz,对食管SNP进行信号平均,并通过同步信号平均对人食管和心内膜所记录的SNP,犬食管和心外膜所记录的SNP进行分析研究.结果记录到食管SNP 189例(74%),所测信号平均食管SNP为P波前的低幅、低频波,可见有2种形态:园顶型(60%)和上斜型(40%);窦房传导时间为(83.3±26.7)ms,分布范围为(23～118)ms;波幅为(3.5～27.7)μV;dv/dt为(0.43～1.93)mV/s.结论在适当滤波、高增益和抗基线漂移技术条件下,利用经食管信号平均技术,大多数窦房结功能正常的患者可直接记录到食管SNP.
목적 탐토무창성경식관신호평균기술직접기록두방결전위(SNP)적방법.방법 채용자제삼도심전미전위검측의대256례두방결공능정상자진행검측,기중남142례,녀114례,년령10～74(44.2±12.4)세.장식관도련적신호방대(증익체도100μV/cm)、려파(0.1～50)Hz,16위모/수(A/D)전환,계통채양빈솔2 kHz,대식관SNP진행신호평균,병통과동보신호평균대인식관화심내막소기록적SNP,견식관화심외막소기록적SNP진행분석연구.결과 기록도식관SNP 189례(74%),소측신호평균식관SNP위P파전적저폭、저빈파,가견유2충형태:완정형(60%)화상사형(40%);두방전도시간위(83.3±26.7)ms,분포범위위(23～118)ms;파폭위(3.5～27.7)μV;dv/dt위(0.43～1.93)mV/s.결론 재괄당려파、고증익화항기선표이기술조건하,이용경식관신호평균기술,대다수두방결공능정상적환자가직접기록도식관SNP.
AIM To develop a noninvasive transesophageal signal averaging technique for direct recording of sinus node electrogram. METHODS Sinus node electrograms were recorded by conventional transesophageal technique from 256 patients (142 male and 114 female, aged from 10 to 74 (mean 44.2 + 12.4). The signals from lead I, surface averaged lead and esophagus averaged lead were amplified (up to 100 μV/cm), filtered (0.1 -50)Hz, AD converted to 16-bit accuracy at a sampling rate of 2 kHz and averaged by using the three-channel low-noise amplifier. To verify sinus node potentials recorded by esophageal lead, electric activities of esophagus/sinus node area and right atrium were simultaneously recorded in humans and in dogs by intracardiac direct record method. RESULTS The signal averaged esophageal sinus node potentials were deflections of low-amplitude and low-frequency preceding the P wave. Two morphologies, the domed wave(114 of 189 patients, 60% ) and the smooth upstroke slope (75 of 189 patients, 40% ) were seen. The directly recorded sinoatrial conduction time was ( 83.3 + 26.7 ) ms, ranging from 23 to 118 ms, amplitude was ( 3.5 - 27.7 ) μV and dv/dt was (0.43 - 1.93 )mV/s. The sinoatrial conduction time recorded by the transesophageal catheter technique was well comparable to that (80.4 + 18.1 ) ms recorded by the transvenous catheter method. CONCLUSION Signal averaged sinus node electrogram can record sinus rhythm in most patients with normal sinus node function. Poper filter settings, high amplification and anti-drift technique are important in recording signal averaged esophageal sinus node electrogram.