宽QRS波心动过速鉴别诊断流程图应用价值.docx

宽QRS波心动过速鉴别诊断流程图应用价值 ［摘要］目的探讨宽QRS波心动过速的鉴别诊断流 程图的临床应用价值。方法 选择2008年2月?2012年2月 在本院心内科和急诊科就诊并经射频消融治疗、心内电生理 检查或食管心房调博确诊为心动过速(WCT)的78例患者， 对其病史、射频消融治疗、心内电生理检查以及食管心房调 博的结果进行回顾性分析。并研究Brugada四步法、aVR导 联四步法联合无人区电轴对于诊断WCT的准确率。结果 采 用Brugada四步法诊断WCT 69例，正确率为8 46%,采用 联合aVR导联四步法及无人区电轴诊断WCT 74例，正确率 为94. 87%O结论 联合应用aVR导联四步法及无人区电轴， 可以大幅度地提高WTC诊断正确率，值得临床推广。 ［关键词］宽QRS波；心动过速；鉴别；诊断流程图 ［中图分类号］R540. 4 ［文献标识码］B ［文章编号］ 1674-4721 (2013) 07 (a) -0000-02 Application value of differential diagnosis flowchart for tachycardia of wide QRS XIE Xiang-qi Department of Cardiology, Hongjiang Hospital, Second People? s Hospital of Huaihua City in Hunan Provicne, Huaihua 418200, China [Abstract] Objective To investigate the clinical application value of differential diagnosis flowchart for tachycardia of wide QRS? Methods Seventy eight patients with wide complex tachycardia (WCT) treated in department of cardiology and emergency , who underwent rendered radiofrequency ablation , and confirmed by intracardiac electrophysiological examination and transesophageal atrial pacing in our hospital from February 2008 to February 2012were selected. Their medical history and resuIts of intracardiac electrophysiological examination and transesophageal atrial pacing were retrospectively analyzed ? The accuracy rate of Brugada four~s tep met hod and four-step met hod of aVR lead combined with axis of no-man? s land in diagnosis of WCT was also studied? Results Sixty nine cases were diagnosed by Brugada four-s tep met hod with accuracy rate of 88. 46%, 74 cases by four-step method of aVR lead combined with axis of no-man， s land with accuracy rate of 94. 87%. Conclusion Application of four-step method of aVR lead and axis of no-man s land can significantly improve the accuracy rate of diagnosing WCT and is worth widely clinical applying. [Key words] Wide QRS ； Tachycardia ； Differentiation； Diagnosis flowchart 宽 QRS 波心动过速(wide complex tachycardia, WCT) 系指以QRS波时限2120 ms、心室率超过100 /min为基本 特点，但其类型、电生理机制与心电图表现各不相同的一类 快速性心律失常[