预激综合征并发房颤和单纯房颤合并室内差异性传导的心电图鉴别诊断  

Differential Diagnosis of Pre-cxcitation Syndrome Complicated With Atrial Fibrillation and Simple Atrial Fibrillation Complicated With Indoor Differential Conduction

作　　者：蒋萍[1] 

机构地区：[1]常州市第三人民医院心电图室,江苏常州213001

出　　处：《中国继续医学教育》2017年第15期106-107,共2页China Continuing Medical Education

摘　　要：目的探究预激综合征并发房颤和单纯房颤合并室内差异性传导的心电图鉴别诊断。方法选取2015年1—12月我院收治的预激综合征并发房颤患者48例作为A组,选择同期我院收治的单纯房颤合并室内差异性传导患者64例作为B组,两组患者均给予上述患者心电监护以及辅助吸氧处理,比较两组患者心电图特征。结果 (1)A组患者中,30例患者快速心室率超过180次/min,占62.5%;B组患者中,23例患者快速心室率超过180次/min,占35.9%;组间对比,差异具有统计学意义(P<0.05)。(2)A组患者均出现连续、快速、畸形、宽大的QRS波群,酷似室性心动过速;B组患者出现连续的宽大QRS波群,呈RBBB型。成串的RBBB型波群频率多为更加快速,但是第1个搏动往往出现在较长R-R间期后,说明是由于室内差传。(3)A组患者的心电图出现波形异型性,QRS-T的升降变化、振幅变化、形态与间歇变化等均不相同,而单纯房颤合并室内差异性传导患者的QRS-T波形比较一致。(4)A组患者发作时,可能典型的预激特征消失,也可能见到预激波。而单纯房颤合并室内差异性传导出现的是束支传导图形。结论单纯房颤合并室内差异性传导、预激综合征并发房颤患者心电图快速心室率、QRS波群、QRS-T波异形性、残留预激特征等指标均不相同,需注意鉴别。Objective To investigate the differential electrocardiogram diagnosis of pre-cxcitation syndrome combined with atrial fibrillation and atrial fibrillation combined with intraventricular differential conduction. Methods From January to December 2015, 48 cases of patients with preexcitation syndrome complicated with atrial fibrillation in our hospital were selected as A group, 64 patients with atrial fibrillation combined with intraventricular differential conduction were selected as B group in our hospital during the same period. The patients were given ECG monitoring and auxiliary oxygen treatment, ECG characteristics between two groups of patients were compared. Results （1） In A group, 30 cases of patients got rapid ventricular rate more than 180 times/min, accounting for about 62.5%; In B group, 23 cases got rapid ventricular rate more than 180 times/min, accounting for about 35.9%, the differences between groups was statistically significant （P〈0.05）. （2） Patients in A group showed continuous, rapid, abnormal and large QRS wave group, which resembled ventricular tachycardia. B group showed continuous large QRS wave group, which was RBBB type. The frequency of RBBB wave group clusters was more rapid, but the first beat often appeared in the long R-R interval, that was due to indoor missions. （3） Patients in A group appeared different ECG waveform atypia, fluctuation, QRS-T amplitude, shape and intermittent changes, but patients in group B appeared similar waveform of QRS-T. （4） When pre- excitation syndrome complicated with atrial fibrillation attack in A group,typical pre excitation characteristics may disappear and pre shock waves can also be observed. The bundle branch conduction pattern appeared in atrial fibrillation combined with intra ventricular differential conduction. Conclusion There are differences about rapid ventricular rate, QRS wave, QRS-T wave, shaped residual pre excitation characteristics of indicators between atrial fibrillation combined with intraventricular differenti

关 键 词：房颤 室内差异性传导 预激综合征 心电图 

分 类 号：R541[医药卫生—心血管疾病]