正常人右胸导联心电图P波形态及性别差异

Difference of P wave shape in right precordial lead electrocardiogram between normal male and female subjects

目的探讨正常人右胸导联心电图男女P波形态差异及变化规律。方法测量900名正常人右胸导联心电图,男女对半,分析P波形态及变化规律。结果右胸导联心电图P波以直立和正负双相P波为主。V1导联直立P波的发生率明显多于正负双相P波的发生率(p<0.01)。从V1～V6R直立P波的发生率依次减少,正负双相P波的发生率依次增多至V4R时,平坦、倒置P波的发生率逐导增多。从V1至V6RP波形态变化以均直立、均正负双相及由直立向正负双相的居多。直立P波振幅及正负双相P波的正相波振幅依次减小并变窄,负相波振幅依次增大并变宽,可直至出现平坦或倒置P波。性别差异:P波电压男性高于女性。男性直立P波发生率多于女性、女性正负双相P波发生率多于男性。V4R～V6R平坦及倒置P波的发生率女性多于男性(p<0.005)。从V1至V6R导联P波形态变化均直立及由直立向正负双相的男性多于女性。由正负双相向倒置及由直立、正负双相、平坦向倒置趋势变化的女性多于男性。结论正常人右胸导联心电图P波形态特征及性别差异,是常规18导联心电图应用必须掌握的一部分。

Objective To explore the difference of P wave in right precordial lead electrocardiogram between normal male and female subjects and its movement pattern. Methods Through measuring right precordial lead electrocardiograms of 900 normal human subjects, evenly separated by sex, P wave shape and pattern of change were compared and analyzed between male and female subjects. Results P wave in right precordial lead electrocardiogram is mainly comprised of the positive and the positive-negative biphasic P waves. The incidence rate of the V1 leads of the positive P wave is apparently higher than that of the positive-negative biphasic P wave（p0.01）. The incidence rate of V1～V6R positive P wave successively decreases, when the incidence rate of the positive-negative P wave successively increase to V4R, the flat P wave and P wave inversion successively increase per lead. The changes of P waves from V1 to V6R are mostly vertical, biphasic, or the transitions from vertical to biphasic. Amplitude of the positive P wave and the positive wave of the positive-negative biphasic gradually decrease per lead, the amplitude of the negative wave gradually increases per lead until the flat P wave or P wave inversion occurs. Sex difference： P wave voltage in male is higher than that in female. The incidence rate of vertical P wave in male is higher than that in female, and the positive-negative biphasic P wave in female occurs more than that in male. The incidence rate of Flat P wave and P wave inversion from V4R to V6R is higher in female than in male（p0.005）. Wave changes from V1 to V6R P are either vertical or vertical-negative positive biphasic, and they occurs more in male than in female patients. The ones with P waves of Negative positive biphasic-inverted, vertical, biphasic, and flat-inverted are seen more in female than in male. Conclusion The P wave pattern in right precordial lead electrocardiogram and its variation between sex is an inseparable part of the regular 18-lead electrocardiogram practice.