“心电图形态学标准”在原有束支阻滞伴宽QRS波群心动过速鉴别诊断中的特异性评价.docVIP

“心电图形态学标准”在原有束支阻滞伴宽QRS波群心动过速鉴别诊断中的特异性评价 江西医药2006年第41卷第4期 心 ? 187? ? 论着? 电图形态学标准在原有束支阻滞伴宽QRS波群心动过速 鉴别诊断中的特异性评价 胡瑁佶林加锋陈露霞(浙江省温州市第三人民医院,温州,325000) 摘要目的探讨心电图形态标准是否适用于原有束支阻滞(BBB)或心肌梗死患者合并宽QRS波群心动过速(WRT)的鉴别诊 断.方法选择窦性心律时呈BBB的患者359例【左柬支阻滞(LBBB)98例,右束支阻滞(RBBB)261例】,分析心电图形态标准用 于鉴别WRT的特异性.结果胸前导联图形一致,胸前导联无RS图形;RBBB时电轴重度右偏(一90~180~),V导联呈左兔耳 征(Rsr.Rr),V导联呈QR,Qs,R形或R/Slt;I,aVF导联呈Qr,QR,QS形;LBBB时V广V2导联s波降支钝挫,V导联q(Q)波, aVF导联呈QS,qR形,I导联呈qR,rs,Rs形等l1项标准特异性较高(_87.7～10o%).另8项标准特异性较低.心肌梗死并 WRT(尤其QRS呈RBBB)时采用上述标准鉴别诊断有一定局限性.结论部分心电图形态标准适用于原有BBB伴wRT的鉴 别诊断,但对心肌梗死并WRT的鉴别价值有限. 关键词心电描记术;心动过速;束支阻滞;心肌梗死;鉴别诊断 中图分类号:R540.41 EvaluationofspecificityofmorphologicalelectrocardiographiccriteriafordifferentialdiagnosisinpatientswithwideQRS complextachycardiafollowingpreviousbundlebrandleblock HuJunji,LinJiafeng,ChenLuxia(Departmentofelectrocardiogram,thethirdpeopleshospitalWenZhou,WenZhou,Zheji~g, 325000,China) AhstractObjectiveToexplorewhetherthemorphologicalelectrocardiographiccriteriawereapplicabletOthepatientwithprevious bundlebrankblock(BBB)ormyocardialinfarctionfollowingwideQRScomplextachycardiainthedifferentialdiagnosis.Methods ThemorphologicalelectrocardiographiccriteriawereusedidentifythespecificityofwideQRScomplextachycardiaamong359pa— tientswithBBB(98withleftBBB,261withrightBBB)insinusrhythm.ResultsThefollowingcriteriaincludingthepresenceofacon— cordialpatterninallprecordialleads,absenceofaRSpatterninallprecordialleadswiththepresenceofBBB;whentheyQRScorn. plexwererightBBB,aleftrabbit—earconfigurationinleadVhQS,qR,RwaveorR/Slt;IinleadV6Qr,QR,QSwaveinleadaVF; whentheyQRScomplexwereleftBBB,notcheddownstrokeSwaveinleadVlorV2,anyq(Q)waveinleadV6oraVF,qR,rS,Rs waveinleadI.all0fthe11criteriahadhighspecificityinpatientswithmyocardialinfamtionaccompanyingwideQaScomplex tachyeardiaitwouldberestraintwhenuseabovecriteriaforthedifferentialdiagnosis.ConclutionPartmorphologicalelectrocardio- graphiccriteriahadhighvalueofdifferentialdiagnosistopatientswithpreviousBBB,butitshadnovalueforthattowhichwithmy— ocard