心电轴偏转在心电图诊断宽QRS波心动过速中的应用价值

Value of cardiac axis deflection in electrocardiographic diagnosis of wide QRS wave tachycardia

目的分析心电轴偏转在体表心电图诊断宽QRS波心动过速(WCT)中的作用。方法选择2018年2月至2019年1月广州医科大学附属第二医院经电生理检查证实的WCT患者124例,回顾性分析患者的临床资料,应用查表法计算WCT和窦性心律下QRS波额面心电轴偏转情况,评估其在体表心电图中鉴别诊断WCT中的临床价值。结果经电生理检查WCT发现,其中室性心动过速(VT)96例(77.4%),室上性心动过速(SVT)28例(22.6%)。WCT中体表心电图QRS波电轴偏转>68°时检出VT、SVT阳性高于电轴偏转>130°(P<0.05);电轴在无人区与电轴偏转>130°时的诊断特异度分别达到100.0%,但敏感度较低(21.86%、27.08%),右束支阻滞型(RBBB)合并电轴左偏多见于VT,其诊断特异度为91.67%;电轴偏转>68°在诊断VT具有较高的特异度(91.67%)、敏感度(54.17%)。结论QRS波额面电轴偏转可准确鉴别诊断WCT,可作为基层医院心脏急症辅助诊断的方式,值得临床推荐应用。

Objective To analyze the role of cardiac axis deflection in the diagnosis of wide QRS wave tachycardia(WCT)by body surface electrocardiography(ECG).Methods A total of 124 patients with WCT confirmed by electrophysiological examination in the Second Hospital of Guangzhou Medical University were selected from February 2018 to January 2019.The clinical data of the patients were retrospectively analyzed,and the look-up table method was applied to calculate the electrocardiographic axis deflection of the frontal plane of the QRS wave under WCT and sinus rhythm to assess its clinical value in the differential diagnosis of WCT in body surface ECG.Results The electrophysiological examination of WCT revealed 96 cases(77.4%)of ventricular tachycardia(VT)and 28 cases(22.6%)of supraventricular tachycardia(SVT).Positive VT and SVT were detected in body surface ECG with QRS wave axis deflections of>68°higher than those with axis deflections of>130°(P<0.05)in WCT.The diagnostic specificity of the electric axes in the no-man′s-land and at axis deflections>130°reached 100.0%,but the sensitivity was lower(21.86%,27.08%).RBBB combined with leftward deviation of the electric axis was seen more often in VT,and its diagnostic specificity was 91.67%.The electric axis deflection>68°had high specificity(91.67%)and sensitivity(54.17%)in diagnosing VT.Conclusion Frontal plane electric axis deflection of QRS wave can accurately identify and diagnose WCT,which can be used as an auxiliary diagnosis of cardiac emergencies in primary hospitals,and is worthy of clinical recommendation and application.