肺支气管病变心电图胸导联R波递增不良患者心电向量图分析

Vectorcardiogram Analysis of Pulmonary Bronchopathy Patients with Poor R Wave Progression in Chest Leads of Electrocardiogram

目的探讨肺支气管病变心电图胸导联R波递增不良患者心电向量图检查额面、横面、右侧面QRS环振幅、方位变化,为临床诊断提供参考。方法选取2016年8月至2017年8月我院住院符合肺结核等肺支气管病变诊断标准的107例患者,行对心电图、心电向量图检查,分析检查结果。结果 107例肺支气管病变且R波递增不良患者通过心电向量图发现超过60%的患者符合右室肥大诊断特征(横面QRS环向前及向右的向量>总面积的70%为68例,横面QRS环位于右后向量>总面积20%为72例,额面QRS环位于右下的向量>总面积20%为72例),而R波递增正常者仅有20%以下符合右室肥大诊断标准(横面QRS环向前及向右的向量>总面积的70%为3例,横面QRS环位于右后向量>总面积20%为4例,额面QRS环位于右下的向量>总面积20%为4例)。107例肺支气管病变患者共有40例患者符合右室肥大心电图诊断特征,而72例符合心电向量图诊断特征。与心电图相比,心电向量图检出率更高,差异有统计学意义(P<0.05)。结论肺支气管病变心电图胸导联R波递增不良患者心电向量图检查额面、横面、右侧面QRS环振幅、方位发生明显变化,提示心电向量对肺支气管病变患者右室肥大有诊断价值。

Objective To investigate the changes of amplitude and orientation of QRS ring on frontal, transverse and right lateral plans of vectorcardiogram in pulmonary bronchopathy patients with poor R wave progression（PRWP） in chest leads of electrocardiogram, and to provide reference for clinical diagnosis. Methods 107 patients meeting the diagnostic criteria for pulmonary bronchopathy like pulmonary tuberculosis,received in our hospital during August 2016 to August 2017, were selected and underwent electrocardiogram as well as vectorcardiogram, their examination results being analyzed. Results More than 60 percent of the 107 pulmonary bronchopathy patients with PRWP met the diagnostic criteria for right ventricular hypertrophy（ there were 68 cases whose forward-direction vector plus rightward-direction vector in QRS ring of transverse plan 〉 70% of the total area, 72 cases whose right backward-direction vector in QRS ring of transverse plan 〉 20% of the total area and 72 cases whose right down- ward-direction vector in QRS ring of frontal plan 〉 20% of the total area） ,while only less than 20% of people with normal R wave progression met the diagnostic criteria for right ventricular hypertrophy （there were 3 cases whose forward-direction vector plus rightward-direction vector in QRS ring of transverse plan 〉 70% of the total area,4 cases whose right backward-direction vector in QRS ring of transverse plan 〉 20% of the total area and 4 cases whose right downward-direction vector in QRS ring of frontal plan 〉 20% of the total area）. Among the 107 patients with pulmonary bronchopathy, only 40 cases met the electrocardiogram diagnostic criteria for right ventricular hypertrophy, while 72 cases met the vectoreardiogram diagnostic criteria. As for right ventricular hypertrophy, vectorcardiogram had higher sensitivity than electrocardiogram, the difference being statistically significan（ P 〈 0. 05 ）. Conclusion Marked changes of amplitude and orientation of QRS ring on frontal, transverse and right lateral plans of vectorcardio-gram in pulmonary bronchopathy patients with PRWP in chest leads of electrocardiogram, can be recorded,indicating the diagnostic value of veetoreardiogram in right ventrieular hypertrophy in patients with pulmonary bronehopathy.