窦性心律诊断标准的探讨

A Study on the Diagnostic Standard of Sinus Rhythm

同步记录麻醉狗心外膜窦房结电图（ＳＮＥｃ）、高位右心房电图（ＨＲＡＥ）及体表ＥＣＧ之Ⅱ、ａＶＲ导联，观察窦房结（ＳＮ）局部注入维拉帕术、电刺激右颈迷走神经、右心房超速起搏及石碳酸破坏ＳＮ前后的变化；发现ＳＮ功能正常时ＳＮＥｃ上Ａ波前有Ｐ前波，ＨＲＡＥ上则无。ＥＣＧ上ＰⅡ直立、ＰａＶＲ倒置。ＥＣＧ及ＳＮＥｃ均为窦性心律，ＳＮ起搏功能发生障碍甚至丧失后，ＳＮＥｃ上Ｐ前波消失，其Ａ波及ＨＲＡＥ之Ａ波形态改变，出现房性逸搏心律。而ＥＣＧ上Ｐ波除形态稍改变外，仍为ＰⅡ直立、ＰａＶＲ倒置。提示ＥＣＧ以“ｐⅡ直立、ＰａＶＲ倒置”作为诊断窦性心律的基本条件不十分可靠；建议应依据ＳＮＥ上有无Ｐ前波来确定是否为窦性心律。

We recorded the change of lead Ⅱ and aVR of ECG, epicardia sinus node electrogram(SNEc)and high right atrial electrogrdm(HRAE)in anaethetic dogs during injecting Verapamil,Normal saline. Phenol into sinus node(SN),stimulating the right cervical vagal nerve and the upper part of right atrium. Respectively, we found that(1) when the function SN was normal,there was pre-P wave prior to atrial wave on SNEc with-out preP wave on HRAE,The P wave was positive on lead Ⅱand negative on lead aVR.The diagnosis was sinus rhythm both on ECG and SNEc.2)when the function of SN was inhibited the pre-P wave on SNEc vanished and could not be recorded from any part of right atrium.The shape of A wave on SNEC and HRAE was different from those before. But P wave was still positive on leaad Ⅱ and nagetive on aVR,The diagnosis on SNEc was atrial rhythm but sinus rhythm on ECG. The diagnosis of ECG was wrong.The study suggested that the difference between sinus rhythm and atrial rhythm can't be distinguished only by recording ECG in some cases and the diagnostic standard Of sinus rhythm-pⅡ positive and aVR negative wasn't perfect.The pre-P wave on SNEc should be regarded as the diagnostic standard of sinus rhythm.