核素动态相影分析法与心电图诊断右束支传导阻滞的对照研究

A COMPARATIVE STUDY OF RIGHT BUNDLE BRANCH BLOCK DIAGNOSED BY RADIONUCLIDE DYNAMIC PHASE ANALYSIS AND ELECTROCARDIOGRAM

用心血池平衡法心血管造影,对心电图(ECG)室内传导正常40例、不完全性右束支传导阻滞(ICRBBB)21例及完全性右束支传导阻滞(CRBBB)32例进行核素动态相影分析(DPHA),二者诊断符合串分别为90%、81%及56%。对诊断不符之处进行探讨,证明DPHA在诊断右束支传导阻滞(RBBB)方面优于ECG。

Forty persons of normal ventricular conduction, 21 of ICRBBB and 32 of CEBBB diagnosed by ECG underwent radionuclide equilibrium cardioangiography for dynamic phase analysis (DPHA). The coincidence rates of diagnosis were 90%, 81% and 56%, respectively. DPHA could demonstrate the path of conduction-contraction of the ventricle directly. ICRBBB displayed delayed speed of conduction in the right ventricle, and the abnormal path (conduction-contraction of the right ventricle originated from the left ventricle and passed through the septum) was the main expression of CRBBB. 14 cases of CRBBB were diagnosed as ICRBBB by DPHA, among them, 2 cases, one of coronary artery disease and the other of pulmonary heart disease, were diagnosed as ICRBBB by ECG previously. The causes of the change of ICRBBB into CRBBB in ECG were dilatation of the ventricle, progression of the degree of bundle branch block, so QRS≥0.12 sec and phase speed was delayed. Thus some ICRBBB might be diagnosed as CRBBB by the standard of QRS≥0.12 sec, 44% was misdiagnosed in this study. 1 case of myocardial infarction of the anterior septum in the normal group, was diagnosed as CRBBB by DPHA, because the change of CRBBB was concealed by Qor Qs in ECG.