摘要目的 探讨法洛四联症(tetralogy of Fallot,TOF)患儿行TOF一期根治术后心率恢复(heart rate recovery,HRR)特点.方法 选取2013年1月至2015年12月在上海儿童医学中心行运动试验检查的TOF一期根治术后患儿32例作为TOF组(男18例,女14例;年龄7～15岁;TOF一期根治术后时间为5～12年)及同期行运动试验检查的健康儿童86例为健康对照组(男42例,女44例;年龄6～14岁).对2组儿童HRR资料进行分析,同时对TOF组运动试验中出现室性心动过速患儿予倍他洛克治疗后的HRR资料进行分析.分别记录运动时峰值心率(HRmax)、恢复期第1 -6分钟心率并计算二者差值,得出第1 -6分钟心率恢复值(HRR1～HRR6).结果 TOF组及健康对照组中运动后前2 min均为心率的快速恢复期,第3分钟进入缓慢恢复期,健康对照组第5分钟进入稳态期,而TOF组第6分钟进入稳态期,TOF组HRR进入稳态期的时间较健康对照组延长.TOF组中运动中达到的峰值心率与健康对照组比较,差异无统计学意义(P＞0.05),但在静息心率[(82.3 ± 3.4)次/min比(79.0 ± 2.5)次/min]、恢复期第1-4分钟心率恢复程度[TOF组:(25.9 ± 1.5)%、(39.4 ± 1.6)%、(43.0 ± 1.6)%、(44.7 ± 1.8)%比健康对照组:(26.3 ± 1.3)%、(40.0 ± 1.1)%、(43. 8 ± 0. 7)%、(45.4 ± 1.4)%]及运动过程中室性期前收缩的发生率[(18/32例,56.3%)比(5/86例,5.8%)]方面, 2组比较差异均有统计学意义(t＝5.77、5.59、10.32、18.65、10.66,χ2＝37.80,均P＜0.05).对于TOF术后运动试验出现室性心动过速的7例患儿予倍他洛克治疗,治疗后患儿静息心率为(77.6 ± 2.6)次/min,明显减慢(t＝3.93,P＝0.01),运动恢复期第1-4分钟心率恢复程度分别为(26.3 ± 1.9)%、(39.8 ± 0.9)%、(43.8 ± 0. 8)%、(46.2 ± 1.3)%,心率恢复明显增高(t＝2.49、4.63、8.30、7.90,均P＜0.05),室性心动过速的发生率为(2/7例,28. 6%)明显降低(χ2＝7.78,P＝0.02).结论 TOF一期术后患儿存在明显的心脏自主神经功能受损,且与TOF术后室性心律失常的发生密切相关,影响TOF术后远期预后.HRR可作为评价及干预治疗后再评价TOF术后患者心脏自主神经功能的重要指标之一.

abstractsObjective To explore the characteristics of postoperative heart rate recovery (HRR)in children who underwent primary radical repair of tetralogy of Fallot(TOF).Methods A total of 32 patients who underwent pri-mary radical repair of TOF were chosen as the TOF group(18 male,14 female,aged from 7 to 15 years old,ranged from 5 to 12 years after primary radical repair of TOF),and 86 healthy children were selected as the healthy control group (42 male,44 female,aged from 6 to 14 years).All children had the treadmill test in Shanghai Children's Medical Cen-ter from January 2013 to December 2015.The data of HRR in 2 groups were reviewed,and the data of HRR were also analyzed in TOF group who had ventricular tachycardia during treadmill test and they were treated with β-blocker.The maximal heart rate(HRmax)at the peak exercise level and the heart rate in 1-6 minute(HRR1-HRR6)in the recovery period were measured and the HRR1-HRR6 was defined as difference between the HRmax and the heart rate in 1-6 minutes during the recovery period.Results The heart rate in first 2 minutes after treadmill exercise showed the rapid recovery in both TOF group and the healthy control group.It recovered slowly after the third minute in two groups.The healthy control group reached the steady HRR period after the fifth minute,whereas TOF group entered the steady HRR period after the sixth minute,and later in the TOF group it reached steady HRR period.There was no difference in HRmax in 2 groups(P＞0.05).But there were significant differences in the resting heart rate[(82.3 ± 3. 4)times/min vs.(79.0 ± 2.5)times/min],and the levels of HRR1-HRR4 minutes were (25.9 ± 1.5)%,(39.4 ± 1.6)%, (43.0 ± 1. 6 )%,and (44. 7 ± 1. 8 )% in TOF group,respectively;while in the healthy control group they were (26.3 ± 1.3)%,(40.0 ± 1.1)%,(43.8 ± 0.7)%,and(45.4 ± 1.4)%;the incidence of ventricular premature beat was 18/32 cases(56.3%)and 5/86 cases(5.8%)during treadmill test between 2 groups (t＝5.77,5. 59,10.32, 18.65,10.66,χ2＝37.80,all P＜0.05).β-blocker treatment was given to 7 cases who had ventricular tachycardia during treadmill test in TOF group.After treatment,the resting heart rate was (77.6 ± 2.6)times/min,significantly de-creased(t＝3.93,P＝0.01),the level of HRR1-HRR4 was(26.3 ± 1.9)%,(39.8 ± 0.9)%,(43.8 ± 0.8)%, (46.2 ± 1. 3)%,respectively,which was significantly increased (t＝2.49,4.63,8.30,7.90,all P＜0.05).The inci-dence of ventricular tachycardia(2/7 cases,28.6%)decreased significantly(χ2＝7.78,P＝0.02).Conclusions There exists cardiac autonomic dysfunction in children who had the primary radical repair of TOF,which is related to the occurrence of ventricular arrhythmia and may influence the long-term prognosis of TOF.HRR can be used as an important indicator to assess and reassess the cardiac autonomic function in patients after TOF repair.