窄QRS波群室上性心动过速时ST-T改变的临床意义

Clinical significance of ST-T changes during narrow QRS complex tachycardia

目的观察ST-T改变对窄QRS波群房室折返性心动过速(AVRT)与房室结折返性心动过速(AVNRT)的鉴别诊断及旁道初步定位的作用。方法分析150例窄QRS波群心动过速患者发作时ST段压低程度及持续时间、T波倒置等情况。结果诊断为AVNRT55例,AVRT95例。ST段压低≥2mm且持续≥100ms者AVRT组(51例,53.68%)多于AVNRT组(15例,27.27%),ST段压低幅度AVRT组(1.58±1.35mm)大于AVNRT组(0.71±0.67mm),心房间传导时间AVRT组(81.02±32.47ms)长于AVNRT组(33.30±13.56ms),差异均有显著性意义(P均<0.05)。ST段压低导联分布左侧游离壁旁道者多见于V3～V6,左后间隔和右后间隔者多见于Ⅱ、Ⅲ、aVF,右侧游离壁旁道者无特异性。结论窄QRS波群室上性心动过速时ST段改变可作为区分AVRT与AVNRT的指标,且有初步旁道定位价值。

Objective To investigate values of ST-T changes in determining type and locating of bypass tracts（BT） of narrow QRS complex tachycardia. Methods To analyze ST segment depression and it＇s durative time and T wave inversion in 12-lead ECGs of one hundred fifty patients with narrow QRS complex tachycardia. Results Fifty five patients were AVNRT and 95 patients were AVRT. ST segment depression≥2mm and durative time≥100ms in group of AVRT （51, 53.68%） had more than that in group of AVNRT（15, 27.27%）. Average of ST segment depression of AVRT（1.58±1.35mm） were lower than it of AVNRT（0.71±0.67mm）.Average of intra-atrial time of AVRT（81.02±32.47ms） were longer than it of AVNRT（33.30±13.56ms）. Two groups of that had significant difference （P〈0.05）. Leads of ST segment depression among left free lateral wall BT frequently appeared in range V3 to V6 leads. Leads of ST segment depression among left posterior septal BT and right posterior septal BT frequently appeared in Ⅱ , Ⅲ ,aVF leads. Leads of ST segment depression among right free lateral wall BT had no significant difference. Conclusion ST-T changes can be used to different AVRT from AVNRT of narrow QRS complex tachycardia. Disturbance of leads with ST segment changes is facilitate to position of BT.