QRS波第一峰时限联合aVR单导联法对宽QRS波心动过速的鉴别诊断价值

Clinical value of R-wave peak time combined with aVR single lead in differential diagnosis of wide QRS complex tachycardia

目的探讨Ⅱ导联QRS波第一峰时限(R-wave peak time,RWPT)与aVR导联QRS波初始R波法联合应用对宽QRS波心动过速(wide QRS complex tachycardia,WCT)的鉴别诊断价值。方法回顾性分析已确诊的132例室性心动过速(ventricular tachycardia,VT)和33例室上性心动过速(supraventricular tachycardia,SVT)患者的心电图形态特征,测量心电图的Ⅱ导联RWPT并观察aVR导联初始波是否为R波,检测应用该方法诊断VT的灵敏度、特异度、准确率、阳性预测值及阴性预测值,并将其结果与RWPT诊断方法进行比较分析。结果运用RWPT结合aVR导联QRS波初始R波法诊断VT的灵敏度96.97%,特异度72.73%,准确度92.12%,阳性预测值93.43%,阴性预测值85.71%;与运用RWPT方法比较,灵敏度、准确度及阴性预测值均显著提高(P<0.05)。结论运用RWPT结合aVR导联QRS波初始R波法对WCT的鉴别诊断具有较高的灵敏度与准确度,而且简便快捷,更加适用于急诊WCT的鉴别诊断。

Objective To investigate the value of R-wave peak time（ RWPT） in lead Ⅱand the method of initial R-wave of QRS complex in lead aVR in the differential diagnosis of wide QRS complex tachycardia（ WCT）. Methods Retrospective analysis was performed on 132 patients diagnosed with ventricular tachycardia（ VT） and 33 cases with supraventricular tachycardia（ SVT）. We analyzed the characteristics of electrocardiogram（ ECG） morphology,measured RWPT in lead Ⅱ and observed whether the initial wave in lead aVR was R-wave or not. In this method,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value in the diagnosis of VT were measured. Then we compared the results with those in the diagnostic method of RWPT. Results When RWPT combined with the initial R-wave of QRS complex in lead aVR were applied in diagnosing VT,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value was 96. 97%,72. 73%,92. 12%,93. 43% and 85. 71%,respectively. Compared with the results in RWPT method,the sensitivity,accuracy and negative predictive value all significantly increased（ P〈0. 05）. Conclusion When RWPT combined with the initial R-wave of QRS complex in lead aVR is applied in the differential diagnosis of WCT,it has high sensitivity and specificity. Due to itssimplicity,convenience and rapidity,the method is more suitable for the differential diagnosis of WCT in emergency.