ࡱ> )`{bjbj {{/JJJJNNN4F$F$F$F$$,<M_CMN_C(--@-----iHiH?---R'hh@@B*CJOJQJmHphsH'hh@@B*CJOJQJmHphsH'hh@@B*CJOJQJmHphsHhh@B*CJOJQJph*hh@5@B*CJOJQJmHphsH*hh@5@B*CJOJQJmHphsH'hh@@B*CJOJQJmHphsH#hh@B*CJOJQJmHphsH'hh@@B*CJOJQJmHphsH"jhh@UmHnHsHtHu\. l*:`s$HHH]H^Ha$gdh@lgdh@ dgdh@ H]H`gdh@$Hl]H`a$gdh@ $dNgdh@$dla$gdh@ $la$gdh@ $a$gdh@H$]H^gdh@ gdh@ z{& Xjl"(*:X qñño_oO__>!hh@hh@B*CJOJQJphhh@@B*CJOJQJphhh@@B*CJOJQJphhh@@B*CJOJQJphhh@@B*CJOJQJphhh@B*CJOJQJph'hh@@B*CJOJQJmHphsH#hh@B*CJOJQJmHphsH'hh@@B*CJOJQJmHphsH'hh@@B*CJOJQJmHphsH'hh@@B*CJOJQJmHphsHf VN^` ~!"ïtbPb@tb.tb@#hh@@B*OJQJmHphsHhh@B*OJQJmHphsH#hh@@B*OJQJmHphsH#hh@@B*OJQJmHphsH#hh@@B*OJQJmHphsH)hh@hh@@B*OJQJmHphsH'hh@@B*CJOJQJmHphsH'hh@@B*CJOJQJmHphsH'hh@@B*CJOJQJmHphsH'hh@@B*CJOJQJmHphsH'hh@@B*CJOJQJmHphsH`""'<*,.2.n//334|jd $dNgdh@$H $$dN]H`a$gdh@$Hl]H`a$gdh@ dlgdh@Hl]H`gdh@gdh@$H]H`a$gdh@$Hd]H`a$gdh@$HH]H`a$gdh@ """""#0$$b%&&'''R(()<**b+ ,,,,r- ..2..l/n/۹˹˹q_q˃#hh@@B*OJQJmHphsH#hh@@B*OJQJmHphsH#hh@@B*OJQJmHphsH#hh@@B*OJQJmHphsH#hh@@ B*OJQJmHphsH#hh@@B*OJQJmHphsHhh@B*OJQJmHphsH#hh@@B*OJQJmHphsH#hh@@B*OJQJmHphsHn//2001(22x3z3333404r4ɷɥn\J8#hh@@B*OJQJmHphsH#hh@@B*OJQJmHphsH#hRP@B*OJQJmHphsH'hh@@B*CJOJQJmHphsHhh@B*OJQJmHphsH%hh@hh@B*OJQJmHphsH#hh@@B*OJQJmHphsH#hh@@B*OJQJmHphsH#hh@@B*OJQJmHphsH#hh@@B*OJQJmHphsH#hh@@B*OJQJmHphsH44440454666@6B6D6F6H6J6Z89RpS $a$gdh@ $`a$gdh@ $`a$gdh@ dgdh@gdh@ $la$gdh@ $l`a$gdh@d $dNgdh@r444`555554666>6@6J6L667.8X8Z8ɷۏ{p[SA1hh@B*OJQJmHphsH#hh@@B*OJQJmHphsHhh@mHsH)hh@hh@B*CJOJQJmHphsHhh@hh@mHsH&hh@6B*CJOJQJmHphsH"jhh@UmHnHsHtHu*hh@6@B*OJQJRHimHphsH#hh@@B*OJQJmHphsH#hh@@B*OJQJmHphsH#hh@@B*OJQJmHphsH#hRP@B*OJQJmHphsHZ8p88888999:P$PPbQRRRR$SmWC&hh@6B*CJOJQJmHphsH*hh@6@B*OJQJRHimHphsH#hh@@B*OJQJmHphsH#hh@@B*OJQJmHphsH#hh@@B*OJQJmHphsHU#hh@@B*OJQJmHphsH#hRP@B*OJQJmHphsH#hh@@B*OJQJmHphsH#hRP@B*OJQJmHphsH#hh@@B*OJQJmHphsH bolesnika (24%), dvoje je imalo blok lijeve grane, a troje druge smetnje provodenja. etvero bolesnika imalo je supraventrikulske aritmije. Samo kod jednog od njih nisu nadene ventrikulske aritmije. U etiri ispitanika nismo ispitivali ventrikulske aritmije (jedan je imao undulaciju atrija, a u troje nisu nadene nikakve poremetnje ritma), (Tablica 2). Tablica 2. Incidencija ventrikulskih aritmija (dituuni .kont elektrokardiografijom) Lown-skupinaBroj bolesnika% bolesnika0419.010-271233.357.1 ni~i stupanj24.83314.33-4942.9 viai4628.6stupanj Iz tablice 2. vidi se da ekstrasistole I stupnja prema Lownu imalo 7, II stupnja 1, III stupnja 3, a IV stupnja 6 bolesnika. Dakle, kod 12 bolesnika (57,1%) bio je prisutan ni~i stupanj aritmije - bilo da su bili bez ekstrasistola ili su one bile prisutne u manjem broju. Kod ostalih 9 bolesnika (42,9%) bio je prisutan viai stupanj aritmija. Peti stupanj nismo ispitivali, kao niti ventrikulsku tahikardiju. Usporeujui stupanj aritmija s istisnom frakcijom, vidljivo je da je 12 bolesnika s ni~im stupnjem aritmije imalo E.F. 15,45% ili prosje no 28%, dok je 9 bolesnika s izra~enim stupnjem aritmija imalo E.F. 15% ili u prosjeku 34% (Tablica 3). Tablica 3. Usporedba stupnja ventrikulske ekstrasistolije s istisnom frakcijom lijevog ventrikula  Broj bolesnikaLown skupinaE. F.(%)Prosjek4020-453071210-215-3515-4527281230303320-554493-415-55346415-4029 Tablica 4. Usporedba istisne frukcije hjevog ventrikula sa stupnjem ventrikulske ekstrasistolije  E. F. (%)Lown skupinaProsjek Broj bolesnika15-250-4B2626-400-4B21241-550-323 Obrnuto gledajui, u 6 bolesnika ija je E.F. izrazito sni~ena (15-25%) pronaeni su svi stupnjevi aritmije. U 12 bolesnika s E.F. 26-48% takoer su prisutni svi stupnjevi aritmija, dok su kod tri bolesnika s E.F. od 41,55% naene aritmije od 0-3 stupnja (Tablica 4). Naai rezultati pokazuju da su ventrikulske aritmije este u bolesnika s kongestivnom (dilatacijskom) kardiomiopatijom. Pribli~no jednako su zastupljene aritmije ni~eg (57,1%) i viaeg stupnja (42,9%). Usporeujui stupanj aritmija s istisnom frakcijom, ustanovili smo, ato je u skladu s podacima iz literature (9, 10, 11, 12, 13,14) da ne postoji korelacija izmedu te~ine ventrikulske aritmije i veli ine istisne frakcije kod kongestivne kardiomiopatije. ZAKLJU AK Kod kongestivne (dilatacijske) kardiomiopatije, vea je incidencija ventrikulskih aritmija nego u zdravoj populaciji i nego kod mnogih drugih sr anih oboljenja. Stupanj aritmije ne korelira s istisnom frakcijom, odnosno stupanj aritmije ne govori o stupnju oateenja lijevog ventrikula. LITERATURA Goodwin, J.F.: Congestive and hypertrophic cardiomyopathies: A decade of study, Lancet, 1:731- 739, 1970. Hadtie, N. i Prirudnik interne medicine, Jumena, Zagreb 1989. Huang, S.K., Messer, J. V., Dense, P.: Significance of ventricular tachycardia in idiopathic dilated cardiomyopathy: observations in 35 patients, Am. J. Cardiol, 51:507, 1983. Von Olshausen, K., Shafer, A., Mehmel, H. C., Schwartz, F., Senges, J., Kubler, W.: Verticular arrhythmias in idiopathic dilated cardiomyophathy, Br. Heart J, 51:195, 1984. Meinertz, T., Hofmann, T., Kasper, W., Treese, N., Bechtold, H., Stienen, U., Pop, T., Leitner, E. R., Andersen, D., Meyer, J.: Significance of ventricular arrhytmias in idiopathic dilatated cardiomyopathy, Am. J. Cardiol, 53:802, 1984 Maskin, C. S., Siskind, S. J., Lejemtel, T. H.: High prevalence of nonsustained ventricular tachycardia in severe congestive heart failure, Am. Heart J, 107:896, 1984. Chakko, C. S., Gheorghiade, M.: Ventricular arrhytmias in severe heart failure: incidence, significance and effectiveness of antiarrhytmic therapy, Am Heart, J, 109:497, 1985. Cardin, J. M., Iseri, L. T., Elkayam, U., Tobis, J., Childis, W., B um, C. S., Henry, W. L.: Evaluation of dilated cardiomyopathy by pulsed doppler echocardiography, Am. Heart, J, 106:1057, 1983. Takarada, A., Yokota, Y., Fukuzaki, H.: Analysis of verticular arrhytmias in patients with dilated cardiomyopathy - relationship between the effects of antiarrhythmic agents and severity of myocardial lesions, Jpn. Circ. J, 54(3): 260-71, 1990. Stein, K. M., Kligfield, P.: Fractal clustering of ventricular ectopy in dilated cardiomyopathy, Am. J. Cardiol, 65(22): 1512.5, 1990. Amosova,E. N.,Kolichenko, V. V., Verich, N. M.: Clinical aspects and diagnosis of dilated cardiomyopathy, KIM. Med. (Mock.), 68(1): 42-7, 1990. Kulick, D. L., Bhandari, A. K., Hong, R., Peterson, R., Leon, C., Rahimtoola, S. H.: Effect of acute hemodynamic decompesation on electrical inducibility ventricular arrhytmias in patients with dilated cardiomyopathy and complex nonsustained ventricular arrbytmias, Am. Heart, J, 119(4): 878-83, 1990. Chetty, S. S., M itha, A. S.: Arrhyttmias in idiopathic dilated cardiomyopathy. A preliminary study, S. Afr. Med. J, 77(4): 190-3, 1990. Allal, J., Poupard, P., Coisne, D., Vieyres, C.,Barraine, R.: Chronic supraventricular rhythm disorders and reversibile dilated cardiomyopathy; Ann. Men. Interne (Paris), 140(7): 6214, 1989. Braunwald: Heart disease, A Textbook of Cardiovascular Medicine, 1989. Natural history of dilated cardiomyopathy (editorial), Lancet, 1: 248, 1986. Rad je primljen u rujnu 1991. 55 E. F.: % izrazito sni~ena (15 jako sni~ena (26 srednje sni~ena (41 Broj bolesnika% Bolesnika- 25%)628,6- 40%)1257,2- 55%)314,2 Medicinar, 37 (1-2): 55 - 59, 1991. 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