继发孔型房间隔缺损的体表心电图改变及与肺动脉高压的关系

Surface electrocardiogram changes of secundum atrial septal defect and its relationship with pulmonary hypertension

目的探讨继发孔型房间隔缺损的体表心电图改变及其与肺动脉高压的关系。方法收集继发孔型房间隔缺损患者74例,统计心电图异常心电的发生情况及相关因素,并根据超声心动图结果将患者分为正常肺动脉压组以及肺动脉高压组,比较两组患者的体表心电图差异。结果继发孔型房间隔缺损患者心电图钩型R波发生率为67. 6%(50/74),不完全性右束支阻滞发生率为58. 1%(43/74),ST-T改变发生率为56. 8%(42/74);年龄是合并不完全性右束支阻滞的影响因素(OR=1. 044,95%CI=1. 009~1. 080,P=0. 012),房间隔缺损大小是发生钩型R波和ST-T改变的影响因素(分别OR=0. 139,95%CI=0. 011~1. 774,P=0. 041;OR=0. 221,95%CI=0. 073~0. 666,P=0. 027);肺动脉高压组患者平均年龄明显大于正常肺动脉压组(P <0. 05),其心电图完全性右束支阻滞和ST-T改变的发生率均显著高于正常肺动脉压组(P <0. 05)。结论体表心电图对继发孔型房间隔缺损及其合并肺动脉高压的诊断具有指导意义。

Objective To investigate the changes of surface electrocardiogram in patients with secundum atrial septal defect( ASD) and its relationship with pulmonary hypertension. Methods Seventy-four patients with secundum ASD were recruited in the study. The incidence of abnormal electrocardiogram and related risk factors were analyzed. According to the results of echocardiography,the patients were categorized into two subgroups: the normal pulmonary artery pressure( NPAP) and the pulmonary artery hypertension( PAH) groups. The differences of surface electrocardiogram between the two groups were compared. Results The incidence of crochetage R wave,incomplete right bundle branch block( IRBBB) and ST-T changes in the electrocardiogram of ASD patients were67. 6%(50/74),58. 1%(43/74) and 56. 8%(42/74),respectively. Older age was significantly associated with IRBBB( OR = 1. 044,95% CI = 1. 009-1. 080,P = 0. 012),whereas atrial defect area was significantly associated with crochetage R wave and ST-T changes( OR = 0. 139,95% CI = 0. 011-1. 774,P = 0. 041;OR = 0. 221,95% CI = 0. 073-0. 666,P = 0. 027). The mean age of patients in PAH group was older than that of NPAP group(P < 0. 05),and the incidence of complete right bundle branch block and ST-T changes in PAH group were significantly increased( P < 0. 05). Conclusion Surface electrocardiogram plays an important role in the diagnosis of secundum ASD with or without pulmonary hypertension.