Ⅱ、Ⅲ、aVF导联R波切迹诊断房间隔缺损的探讨

The study of the notch on R wave in Ⅱ、 Ⅲ 、aVF leads of ECG for diagnosing atrial septal defect

目的探讨心电图Ⅱ、Ⅲ、aVF导联R波切迹对检出房间隔缺损(ASD)的意义。方法分析74例ASD心电图,74名正常人作为对照组。ASD的诊断均经超声心动图证实和未予手术矫正。结果 74例ASD心电图中,Ⅱ、Ⅲ、aVF导联出现R波切迹者44例(59.5%),其中8例(10.8%)于Ⅱ、Ⅲ、aVF导联中的一个导联出现R波切迹,16例(21.6%)两个导联出现R波切迹,20例(27.6%)三个导联同时出现R波切迹。正常人组中仅7例)9.4%)在Ⅱ、Ⅲ、aVF导联中出现R波切迹,一个导联、两个导联及三个导联出现R波切迹的例数分别为3例(4.0%)、2例(2.7%)和2例(2.7%)。ASD组心电图Ⅱ、Ⅲ、aVF导联出现R波切迹比率显著高于正常人组(59.5%vs.9.4%,p<0.005)。以心电图Ⅱ、Ⅲ、aVF导联出现R波切迹诊断ASD的敏感性和特异性分别为59.5%和90.5%。结论心电图Ⅱ、Ⅲ、aVF导联R波切迹是心电图诊断ASD的一项指标。

Objective To investigate the significance of the notch on R wave inⅡ、Ⅲ、aVF leads of Electrocardiogram（ECG） for diagnosing patients with atrial septal defect. Methods ECGs of 74 patients diagnosed as atrial septal defect（ASD） and ECGs of 74 normal control subjects were reviewed. The pattern of the notch on R wave inⅡ、Ⅲ、aVF leads of ECG were analyzed. All of the patients with ASD were confirmed by echocardiography and had not been corrected. These ECGs were compared with 74 cases of normal control subjects. Results The notch on R wave was observed in 44 cases（59.4%） of 74 patients with ASD in at least one lead of Ⅱ、Ⅲ、aVF leads, in which 8 cases（10.8%） showed the notch on R wave in only one lead, 16 cases（21.6%） showed in two leads,20 cases（27.6%） showed in all three leads. While this pattern was observed in 8 cases（21.6%） of 74 normal control subjects in at least one lead of Ⅱ、Ⅲ、aVF leads, in which 4 cases（4.0%） showed this pattern in only one lead, 2 cases（2.7%） in two leads, 2 cases（2.7%） in all three leads. The incidence of the pattern of the notch on R wave in Ⅱ、Ⅲ、aVF leads of ECG in patients with ASD was significantly higher than that in normal control subjects（59.5% vs. 9.4%, p〈0.05）. The sensitivity and specificity of this ECG pattern for diagnosing proven ASD were 59.5% and 90.5% respectively. Conclusions The notch on R wave in Ⅱ、Ⅲ、aVF leads of ECG is a valuable pattern for diagnosing atrial septal defect.