室上性宽QRS波群心动过速的临床分析

The Clinical analysis of supraventricular tachycardia with wide QRS complex

目的对自发室上性宽QRS波群心动过速的临床特征、心电图特点进行分析,并用Brugada4步诊断法与室速进行鉴别诊断,评价其敏感性及特异性。方法选择入院时为心动过速的患者,符合窦性P波消失、心室率>100bpm且QRS波群时限≥0.12s,心脏电生理检查明确诊断后,采用单盲法回顾性分析12导联体表心电图的形态学特征,独立做出诊断后,计算Brugada4步诊断法的特异性和敏感性并评价其实用性,同时分析其临床特征及血液动力学改变。结果入选50例室上性宽QRS波群心动过速患者,46例诊断为室上速伴束支阻滞或心室内差异性传导,特异性92%,敏感性100%;心室率<180bpm组与心室率>180bpm组,两组的平均收缩压、平均舒张压及平均动脉压(平均动脉压=舒张压+1/3脉压)均有差别,心室率较快组血压较低,p值<0.05,差别有统计学意义。结论Brugada法对室上性宽QRS波群心动过速的鉴别诊断有重要意义,正确的诊断和及时的处理对患者至关重要。

Objective The clinical and ECG feature of spontaneous supraventricular wide QRS complex tachycardia was analyzed, and using the differential diagnosis of Brugada, SVT and VT was differented and the sensitivity and specificity was evaluated. Mthods The patients of tachycardia was selected while they was diagnoted, when tachycardia was diagnosed, P wave vanished and heart rate〉100 beat per minute and QRS time 120ms. After diagnosis being confirmed, the morphological features of surface 12-lead ECG were analyzed and diagnosed retrospectively, with single-blind method. After diagnosed, the specificity and sensitivity of Brugada method were calculated, while the clinical feature and blood dynamics changes were analyzed. Results 46 cases were SVT with BBB or intraventricular differential conduction in all of 50 patients, the blood press of two sets of 〈180bpm or 〉180bpm was different,P〈0.05,and the difference was significant in statistics. Conclusions The method of Brugada was very significant for differential diagnosis of supraventricular wide QRS complex tachycardia, and correct diagnosis and timely treatment were vital for patients.