【摘要】 目的 探讨心脏自主神经系统(ANS)对房室传导系统的昼夜持续性调节作用。方法 患者分两组：组Ⅰ93例，均为慢性心房颤动；组Ⅱ 60例，均为窦性心律者。对两组患者行24小时动态心电图检测，观察其心室节律的昼夜分布特征。然后给组Ⅰ服用美托洛尔，并重复动态心电图检查。结果 圆分布资料的统计学处理显示，组Ⅰ患者用药前与组Ⅱ的心室节律有相同的分布特征，即于5：00～6：00时达谷值，于11：00～12：00时达峰值。表明ANS对窦房结与房室结兴奋与抑制时相的调控作用相似。组Ⅰ患者服用美托洛尔后其平均心室率下降，但其心室反应的昼夜分布特征无改变。结论 ANS对房室结区与窦房结的调控作用相似；美托洛尔仅能降低心房颤动患者平均心室率而不能影响房室结区的兴奋与抑制时相。

    The diurnal distribution of ventricular response in patientswith atrial fibrillation Guo Yifang, Ma Shu-ping,Liu Kunshen. Geriatric Institute, HeBei Provincial People's Hospital, Shijiazhuang 050051

    【Abstract】 Objective To evaluate thecharacteristics of continue neural regulation of atrioventricular conduction and theeffects of metoprolol on it. Methods One hundred andfifty-three patients were divided into two groups: Group Ⅰ, 93 patients with chronic atrial fibrillation, and group Ⅱ, 60 patients with normal sinus rhythm. 24-hours ambulatory electrocardiograms were recorded in all the patients, and in the patients of group Ⅰ 2 weeks after oral metoprolol. The characteristic of diurnaldistribution of the ventricular response was identified. Results The circadin data were statistically analyzed. We found that, thediurnal distribution of ventricular response in group Ⅰ (before metoprolol administration) was the same as that in group Ⅱ, which was also the same before and after metoprolol administration in group Ⅰ, but the average heartrate was decreased in this group. Conclusion Thecharacteristic of continue regulation of autonomic nervous system was similar betweensinus node and atrio-ventricular node; the metoprolol decreased the average heart rate ofatrial fibrillation patients, but did not change the excitation and inhibition phase.

     【Key words】 artrial fibrillation heartconduction system autonomic nervous system

     ......