P波时限及离散度在慢性充血性心力衰竭并阵发性心房颤动的预测价值  

The predictive value of P-wave duration and dispersion and the chronic congestive heart failure in patients with paroxysmal atrial fibrillation

作　　者：谭志伟 周怀根 叶翠河 阮国永 

机构地区：[1]广东省新兴县人民医院心内科,527400

出　　处：《中国临床实用医学》2008年第5期30-32,共3页China Clinical Practical Medicine

基　　金：云浮市医药卫生科研项目（项目编号：20068043）

摘　　要：目的探讨P波时限及离散度在慢性充血性心力衰竭（CHF）并阵发性心房颤动患者的预测价值。方法对确诊65例患者采用12导联同步体表心电图记录（纸速50mm／s），4次／月，记录的心电图取基线平稳，图形清晰的心动周期进行采样测量，12导联P波宽度测量后，取最大P波时限（Pmax）及最小P波时限（P～），两者的差为P波离散度（Pd）（即Pd=Pmax-Pmin）。以Pmax≥110ms、Pd〉t40ms为阳性标准，随访1年，并对所有数据作统计学分析。结果患者阵发性心房颤动发作时，P波离散度（Pd）和P～明显增大（P〈0．01），当患者心电图Pmax≥110ms时，其预测充血性心力衰竭患者伴发心房颤动的灵敏度最高，但特异性却不如Pdt〉40ms及（Pmax≥110ms）＋（Pdt〉40ms），而且阳性预测值也明显低于后两者。其中以（Pmax≥110ms）联合（Pd≥40ms）的特异性和阳性预测值均最高。另外患者心房颤动发作前后左心房内径（LAD）和左心室射血分数（LVEF）变化有统计学意义（P〈0．05）。结论Pmax联合Pd在CHF患者中并发心房颤动具有较高的预测价值。联合利用这两项指标来预测房性心律失常，特别是那些未被体表心电图证实的阵发性心房颤动患者，具有重要的临床意义。Objective To evaluate the predictive value of P-wave duration and dispersion and the chronic congestive heart failure in patients with paroxysmal atrial fibrillation. Methods 65 cases diagnosed in a 12- lead ECG synchronization surface records（ paper speed of 50 mm/s） ,four times a month,records from the baseline ECG smooth, cleargraphics cardiac cycle sampling measurement. 12-P-wave width measurement, from the largest P-wave duration（Pmax ）and the smallest P-wave duration（ Pmin ） , the P-wave dispersion is less Pmin Pmax Pmax≥110 ms and Pd ≥40 ms are as positive standards,in 1 year follow-up,and all datas are for statistical analysis. Results Attack patients with paroxysmal atrial fibrillation, Pd and Pmax significantly increased （P 〈 0. 01 ）. And when patients with ECG Pmax ≥ 110 ms, the sensitivity of the highest forecast the congestive heart failure with atrial fibrillation. However,specificity was not than Pd ≥ 40 ms and（ Pmax ≥ 110 ms） ＋ （ Pd ≥ 40 ms） , And the positive predictive value was significantly lower than the latter two also. To which （Pamx ≥ 110 ms）joint（Pd ≥ 40 ms）of the specificity and positive predictive value were highest. Also before and after the onset of atrial fibrillation in patients with left atrial diameter（ LAD ）and left ventricular ejection fraction（LVEF） changes in the statistical significance（ P 〈 0. 05 ）. Conclusion Pmax joint Pd in CHF patients with atrial fibrillation have a higher predictive value. To use this 2 indicators to predict atrial arrhythmia, Especially those who have not been confirmed surface electrocardiogram in patients with paroxysmal atrial fibrillation, have important clinical significance.

关 键 词：P波时限 P波离散度 充血性心力衰竭 阵发性心房颤动 预测 

分 类 号：R541.7[医药卫生—心血管疾病] R541.6[医药卫生—内科学]