冠心病心力衰竭伴肺动脉压升高对心电图V1导联P波终末电势的影响

The effect on V1 P wave terminal voltage of increased pulmonary artery pressure which happens in coronary heart disease patients who have heart dysfunction

目的探讨冠心病心功能不全伴肺动脉压力升高者心电图V1导联P波终末电势（PTFW1）改变的影响。方法选择2011年1月至2013年12月160例冠心病心功能不全的住院患者，依据多普勒超声测量的肺动脉压（PAP）升高和正常分为2组：肺动脉压升高，PAP≥40mmHg的98例为试验组；肺动脉压正常，PAP〈40mmHg的62例为对照组。计算两组患者超声测量的E峰／A峰比值（E／A）、左室射血分数（EF）、PAP和心电图PTFV1值，比较两组间总的差异性。与此同时，比较试验组中肺动脉压力轻度（PAP=40-50mmHg）、中度（PAP=51-70mmHg）和重度升高（PAP≥70mmg）对PTFV1值的影响。结果（1）试验组的E／A和EF值低于对照组[0．85±0．17、（41．4±10．26）％]vs．[1．03±0．22、（48．1±7．03）％]，P〈0．05]，而PTFV1绝对值却大于对照组[-（0．116±0．044）mm／s vs．-（0．085±0．029）mm/s，P〈0．01]，说明试验组心室舒张和收缩功能减退程度大于对照组，PTFV1绝对值的增大与心衰的严重程度相一致。（2）在PAP轻度、中度和重度升高的试验组患者中，PTFV1绝对值也依次增大，分别为-（0．089±0．027）mm／s、-（0．136±0．034）mm／s和-（0．202±0．031）mm／s，其差异均有显著性统计学意义（P〈0．01），表明PTFV1绝对值伴随PAP的升高而增大。结论PTFV1绝对值的增大与冠心病心功能不全和PAP升高有明显的相关性，动态监测心电图PTFV1值的变化对于认识左心功能不全伴发的被动性肺动脉压的升高有重要的临床意义。

Objective To investigate the effect of pulmonary artery pressure （PAP） on P-wave terminal force in lead V1 （PTFV1）, that associated with cardiac insufficiency in patients of coronary heart disease. Methods from January, 2011 to December, 2013, based on Doppler ultrasound measurement of pulmonary artery pressure （PAP）, 160 cases of coronary heart disease with cardiac insufficiency were divided into 2 groups： 98 cases were greater than 40 mmHg in trial group; 62 cases were less than 40 rnmHg as control group. The E peak/A peak ratio （E/A）, left ventricular ejection fraction （EF） and PAP of two groups were calculated by ultrasound, at the same time, the PTFV1 of ECG were measured. Then, those data were compared between the two groups. Meanwhile, comparing the effect of PAP on PTFV1, PAP of 40-50 mmHg, 51-70 mmHg and more than 70 mmHg which in the trial group. Results （1）The E/A and EF value in trial group were lower than that in normal group, the result was 0.85±0.17, （41.4±10.26）% vs. 1.03±0.22, （48.1±7.03）%, P〈0.05 and P〈0.01, but the PTFV1 absolute value in trial group were higher than that in normal group, the result was -（0.116±0.044）mm/s vs. -（0.085±0.029）mm/s, P〈0.01, which showed that increased PTFV1 was companied by decreased E/A and EF. There was nodoubt to ventricular diastolic and systolic dysfunction in trial group was greater than in normal group. （2） The values of PTFV1 of patience with mild, moderate and severe increase of PAP were -（0.089±0.027）mm/s, -（0.136±0.034）mm/s and -（0.202±0.031）mm/s, respectively. There is difference among them, and P〈0.01. Obviously, there was a correlation between PTFV1 had something to do with and PAP. Conclusion There is a correlation between the increased PTFV1 and increased PAP which happens in coronary heart disease patients who have heart dysfunction. It is of important significance for guiding the clinicians towards the better understanding of increased PAP in coronary heart disease with heart dysfunction.