左冠状动脉异常起源于肺动脉的心电图特点及术后转归  

ECG Characteristics and Post Operative Changes in Patients With Anomalous Origin of Left Coronary Artery From Pulmonary Artery

作　　者：冯雪[1] 李晓峰[1] 袁越[1] 张励兵[1] 宋振江[1] 

机构地区：[1]首都医科大学附属北京儿童医院心脏中心心电图室,北京市100045

出　　处：《中国循环杂志》2012年第4期291-294,共4页Chinese Circulation Journal

摘　　要：目的:探讨左冠状动脉异常起源于肺动脉的心电图诊断特点和术后异常Q波变化。方法:收集我院心脏外科2006-01至2011-12实施左冠状动脉异常起源于肺动脉手术患儿12例,分为婴儿组(≤1岁,n=6)和儿童组(>1岁且≤5岁,n=6),对术前12例心电图和术后存活9例异常Q波的12个月随访结果进行分析。心电图主要分析:①Ⅰ、aVL导联异常Q波和T波倒置;②V4～6导联异常Q波和ST-T改变;③左心室肥厚;④术后Ⅰ、aVL、V4～6导联异常Q波变化。超声心动图观察左心室收缩功能变化。结果:两组在Ⅰ、aVL导联异常Q波和T波倒置、V4～6导联ST-T改变出现率均很高,差异无统计学意义(P>0.05);术前婴儿组V4～6导联异常Q波出现率明显高于儿童组(P<0.05);术后1、6、12个月随访,儿童组异常Q波缓解程度明显高于婴儿组(P<0.05),婴儿组左心室收缩功能改善明显。结论:小儿心电图Ⅰ、aVL导联异常Q波和T波倒置是诊断左冠状动脉异常起源于肺动脉的重要依据,V4～6导联异常Q波是婴儿型与儿童型鉴别的重要依据。对小婴儿早期实施外科手术,有利于异常Q波得到缓解、最终消失及左心功能改善。Objective：To explore the diagnostic characteristics of electrocardiography （ECG） and post operational changes of abnormal Q wave in patients with anomalous origin of left coronary artery from pulmonary artery（ALCAPA）. Methods： We retrospectively summarized 12 post operative ALCAPA pediatric patients who were treated in our hospital from 2006 to 2011, and divided them as Infant group, the patients with the age〈 1 year, and Children group, the patients with the 1 year 〉agc≤5 years, n=6 in each group. We analyzed 12 pre-operative ECG and 9 post operative survival＇ s ECG in 1 year follow-up time by the main parameters of ①abnormal Q wave and T wave inversion in Ⅰ and aVL leads,②abnorrnal Q wave and ST-T changes in V4 -6 leads ,③left ventricular hypertrophy, and ④post operative abnormal Q wave in Ⅰ, aVL and V4-6 leads. Echocardiography was performed to monitor the changes of left ventricular systolic function. Results ： There were similar high frequencies of abnormal Q wave and T wave inversion in Ⅰ and aVL leads and ST-T changes in V4 -6 leads in both groups ,P〉0.05. The frequencies of pre-operative abnormal Q wave in V4 -6 leads were higher in Infant group than that in Children group, P〈0. 05. At 1,6 and 12 months post operative follow-up examination, the alleviation degree of abnor- mal Q wave in Children group was higher than that in Infant group ,P〈0. 05 ,while the Infant group presented obviously improved left ventricular systolic function. Conclusion：The abnormal Q wave and T wave inversion in ECG Ⅰ and aVL leads are important for ALCAPA diagnosis in pediatric patients. The early operation is helpful for infants in abnormal Q wave alleviation with the improved left ventricular func-tion.

关 键 词：左冠状动脉起源异常 心电图 异常Q波 儿童 心脏手术 

分 类 号：R541[医药卫生—心血管疾病]