慢性心力衰竭患者心电图呈现低电压的临床分析

Low voltage of electrocardiogram in patients with chronic heart failure

目的分析慢性心力衰竭(心衰)患者心电图呈现低电压的情况。方法选择2012年2月至2014年7月在河北省人民医院心血管内科进行诊治的慢性心力衰竭患者200例为病例组,选择同期在我院行健康体检者200例为对照组。所有患者入院时行常规心脏超声检查,测定左心室收缩末内径、左心室舒张末内径、心胸比等。统计不同导联下QRS低电压发生情况。结果病例组较对照组左心室收缩末内径[(60.49±5.39)mm vs.(29.80±3.36)mm]、左心室舒张末内径[(72.77±6.11)mm vs.(47.38±3.60)mm]、心胸比[(0.58±0.09)vs.(0.42±0.04)]升高,有统计学差异(P<0.05)。与对照组比较,病例组肢体导联电压振幅明显降低,而QRS间期明显增宽,QTc间期明显延长,分别为(8.82±2.14)m V vs.(4.33±2.13)m V,(76.39±17.33)ms vs.(109.38±18.33)ms,(219.37±45.39)m V vs.(444.98±34.29)m V,差异有统计学意义(P均<0.05)。左前降支(LAD)病变Ⅲ导联QRS低电压较多,左回旋支(LCX)病变Ⅱ导联和Ⅲ导联QRS发生低电压。结论慢性心力衰竭多伴随有超声与心电图指标的异常,也表现为QRS波群低电压状况。

Objective To analyze the low voltage of electrocardiogram （ECG） in patients with chronic heart failure （CHF）. Methods CHF patients （n=200, patient group） were chosen and other healthy controls （n=200, control group） were chosen from Feb. 2012 to July 2014. All patients were given routine cardiac echocardiography examinations for detecting left ventricular end-systolic diameter （LVESd）, left ventricular end-diastolic inner diameter （LVEDd） and cardio-thoracic proportion, and observing the occurrence of QRS low voltage in different leads. Results LVESd [（60.49±5.39） mm vs. （29.80±3.36） mm], LVEDd [（72.77±6.11） mm vs. （47.38±3.60） mm] and cardio-thoracic proportion [（0.58±0.09） vs. （0.42±0.04）] increased in patient group compared with control group （P〈0.05）. Compared with control group, voltage amplitude of limb lead decreased, QRS duration increased significantly and QTc duration was significantly prolonged [（8.82±2.14） mV vs. （4.33±2.13） mV, （76.39±17.33） ms vs. （109.38±18.33） ms, （219.37±45.39） mV vs. （444.98±34.29） mV, all P〈0.05]. More QRS low voltage in III lead was observed in patients with LAD lesion, and QRS low voltage in II lead and III lead was observed in patients with LCX lesion. Conclusion CHF is commonly accompanied by abnormal ultrasound and ECG indexes and QRS low voltage.