头胸导联结合冠状动脉计算机断层扫描血管造影对冠心病患者右胸异常q波的鉴别  

Discrimination of abnormal Q waves in right chest leads with head-chest lead electrocardiogram and coronary artery computed tomography angiography in patients with coronary heart disease

作　　者：王伟[1] 邓玉[1] 邱健[2] 

机构地区：[1]广州军区广州总医院干部病房五科,广州510010 [2]广州军区广州总医院心血管内科,广州510010

出　　处：《岭南心血管病杂志》2016年第4期430-432,445,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的通过头胸导联对右胸异常q波的观察，结合冠状动脉计算机断层扫描血管造影（CTA）结果，评价其对常规心电图右胸导联异常q波的鉴别作用。方法根据冠状动脉计算机断层扫描血管造影（computedtomographyangiography，CTA）所判断的右冠状动脉狭窄程度，将48例冠状动脉粥样硬化性心脏病（冠心病）患者分为A（20例）、B（28例）两组，前者右冠状状动脉狭窄程度为95％～100％，后者右冠状动脉狭窄程度为〈50％。所有患者均给予同步记录常规心电图（RLECG）的V3R到V8R和头胸导联心电图（HCECG）HV3B到HV8R。结果A组两种心电图配对的导联q波出现率比较，差异无统计学意义（P=0．5～0．756）。B组两种心电图配对的导联q波出现率比较，差异有统计学意义（P=0．000～0．005）。头胸导联心电图和常规心电图对右胸导联异常q波的敏感性分别为60％～100％和53．8％～90．5％、特异性分别为96．7％～100％和0．6％～80．6％。右冠状动脉近端（15例）、中段（4例）和远端（1例）。重度狭窄闭塞患者分别在HV3R～HV8R、HV5R～HV8R和HV6R～HV8R导联可见异常q波。结论头胸导联心电图有助于对常规导联右胸异常q波的进一步鉴别，并提示右冠状动脉病变部位与异常q波在头胸导联心电图右胸的导联部位呈一定相关性。Objectives To evaluate the discrimination value of head-chest electrocardiogram （HCECG） combined with coronary artery computed tomography angiography （CTA） in discriminating abnormal Q waves in right chest leads. Methods According to the degree of stenosis of fight coronary artery, 48 patients were divided into group A （n=20） and group B （n=28）. Stenosis of group A was 95% to 100% and group B was less than 50%. All the patients were performed examination of routine lead electrocardiogram （RLECG） and HCECG synchronously in leads V3R to VSR and HW3R to HV8R- Results The results showed that in group A, there was no significant difference in occurrence rate of abnormal Q waves in both kinds of ECG （P=0.5 to 0.756）, however, in group B, the difference was significant （P= 0.000 to 0.005）. The sensitivities of HCECG and RLECG to abnormal Q waves in right chest leads were 60% to 100% and 53.8% to 90.5% respectively. The specificities of HCECG and RLECG to abnormal Q waves in right chest leads were 96.7% to 100% and 0.6% to 80.6% respectively. Abnormal Q waves founded in HV3R-HVsR, HV5R-HV8R and HV6R-HV8R were respectively related to severe stenosis of proximal （n=15）, middle （n=l） and distal （n=l） right coronary artery. Conclusions HCECG may be helpful in discriminating abnormal Q waves occurring in fight leads of RLECG and the location of abnormal Q waves founded in fight chest leads of HCECG may have some relationship to the lesion of stenosis of fight coronary artery.

关 键 词：头胸导联 常规导联 心电图 右胸 异常Q波 冠状动脉计算机断层扫描血管造影 

分 类 号：R543[医药卫生—心血管疾病]