体表心电图I导联QRS呈宽M型左束支传导阻滞的左心室同步性分析  

Analysis of ventricular synchronicity in atients with broad "M" shape in QRS wave of lead I of ECG in left bundle branch block

作　　者：刘盛林[1] 黄金康[1] 陈明[1] 刘怡[1] 张宇辉[1] 杜溪溪[1] 陈田[1] 

机构地区：[1]同济大学附属东方医院超声与功能科,上海200120

出　　处：《临床心血管病杂志》2010年第4期303-306,共4页Journal of Clinical Cardiology

基　　金：上海市浦东新区卫生科技面上项目(No:PW2006A-6)

摘　　要：目的：运用组织多普勒和实时三维超声心动图技术分析体表心电图I导联呈宽M型左束支传导阻滞（LBBB）患者的左心室同步性。方法：按体表心电图I导联QRS波是否呈宽M型将46例LBBB患者分为LBBBM型组（20例）和LBBB非M型组（26例）,并选择正常对照组40例。用组织多普勒技术分别测定2组患者左心室心肌12个节段的收缩达峰时间（TS）,并计算达峰时间差（△TS）;以△TS〉65ms为标准,判断心肌同步性。用实时三维超声测定左室舒张末容积、收缩末容积和左室射血分数,并应用Qlab定量分析软件,对所有患者的实时三维超声图像对三维数据库进行定量分析,测得到左室整体容积曲线、17节段容积曲线、17节段的平均最大容积（Vmax）及其标准差（Vmax-SD）、平均最小容积（Vmin）及其标准差（Vmin-SD）、最小容积点距离心电图Q波起始点的平均时间（T）及其标准差（T-SD）、17个节段中的最小容积点距离心电图Q波起始点的最大时间差（Tmax）。结果：①以同一心肌壁内不同节段间的△TS〉65ms为心肌收缩不同步标准,计算LBBBM型组患者中左心室心肌非同步化的发生率为85.00%（17/20）,明显高于LBBB非M型的57.69%（15/26）,P〈0.05;②LBBBM型组与LBBB非M型组间Vmin-SD、T-SD和Tmax差异均有统计学意义（P〈0.05-0.01）。结论：采用组织多普勒超声心动图与实时三维超声心动图证实,在体表心电图I导联QRS波呈宽M型的LBBB患者中左心室心肌运动不同步的发生率较高。Objective：In order to assess the left ventricular function and synchronicity, tissue Doppler echocardiography（TDI） and real-time and three-dimensional echocardiography（3DE） were performed on patients with the broad ＂M＂ shape in QRS wave of lead I of ECG in left bundle branch block（LBBB）.Method：Forty-six patients were divided into group of M shape（n=20） and group of non-M shape（n=26）, according to the shape of QRS wave in ECG, and 40 cases of healthy subjects as control. Synchronicity was determined as maximal difference in delay（△TS） 〉65 ms.Time-to-peak myocardial contraction（Ts） by TDI. EDV, ESV and EF were meassured by 3DE. From 17 segments-volumn curve, maximal segments-volumne（Vmax）, standard diviation of Vmax（Vmax-SD）, minimal segments-volumne（Vmin）, standard diviation of Vmin（Vmin-SD）, time-to-peak minimal segments-volumne （T）, standard diviation of T（T-SD） and time difference of T（Tmax） were obtained. Result：①Ventricular asynchronicity（VA） was 85.00% （17/20） in the Group of broad M shape and VA was 57.69% （15/26） in the Group of non-M shape （P〈0.05）, according to the critiaria of △TS〉65 ms; ②There were siginificant differences in Vmin-SD, T-SD and Tmax （P〈0.05 -0.01）. Conclusion：Incidence of asynchronicity in broad M shape on lead Ⅰ of ECG in patients with LBBB was higher than that in patients of non-M shape by TDI and 3DE. It seems that broad M shape on lead Ⅰ of ECG in LBBB was an indication of treatment of synchronization.

关 键 词：心电描记术 左束支阻滞 组织多普勒成像 实时三维超声心动图 心肌同步 

分 类 号：R540.4[医药卫生—心血管疾病]