三维Lorenz散点图精解:阻滞篇  

Fine analysis of three-dimensional Lorenz scatter plot:blocked arrhythmia

作　　者：景永明[1] 李世锋[1] 张芳芳[1] 杨伟[1] Jing Yong-ming;Li Shi-feng;Zhang Fang-fang;Yang Wei(Department of Electrocardiogram,the Second Affiliated Hospital of Zhengzhou University,Zhengzhou Henan 450014,China)

机构地区：[1]郑州大学第二附属医院心电图科,河南郑州450014

出　　处：《实用心电学杂志》2020年第6期397-406,共10页Journal of Practical Electrocardiology

基　　金：河南省重点研发与推广专项(182102311218)。

摘　　要：本文精选了3个阻滞性心律失常的经典病例,在精解其二维时间散点图、Lorenz散点图、差值散点图的基础之上,循序渐进地探讨其三维Lorenz散点图的规律性。分析和总结二度Ⅰ、Ⅱ型房室传导阻滞,三度房室传导阻滞的三维Lorenz散点图特征,对比二维Lorenz散点图及差值散点图与三维Lorenz散点图的内在联系。结果表明:二度Ⅰ、Ⅱ型房室传导阻滞的散点图各具特征,可快速识别;三度房室传导阻滞表达逸搏心律的电生理特征:逸搏周期相对固定,逸搏心律随时重整;其散点图最大特征是早搏后点集或夺获后点集重叠在等速线的主导节律中,早搏点集与早搏前点集对称分布于等速线两侧;房室关系的判断及逸搏性质的确认往往需要借助逆行技术及瀑布图分析等手段;二维Lorenz散点图等同于三维Lorenz散点图的xOy面、yOz面;二维差值散点图相当于三维Lorenz散点图的xyz面,三维Lorenz散点图的xyz面图形相对更紧凑、描述更方便,也容易理解;zOx面仍对称分布于空间等速线。This paper carefully selects three classic cases of blocked arrhythmia,and explores the regularity of their three-dimensional Lorenz scatter plots step by step based on the detailed analysis of their two-dimensional time scatter plot,Lorenz scatter plot and difference scatter plot.The three-dimensional Lorenz scatter plot characteristics of second degree typedⅠandⅡatrioventricular block(AVB),and third degree AVB were analyzed and summarized.The intrinsic correlation of three-dimensional Lorenz scatter plot with two-dimensional Lorenz scatter plot and difference scatter plot was compared.The results show different features in the scatter plots of second degree typedⅠandⅡAVB,which serves for rapid identification.The Lorenz scatter plot of third degree AVB expresses electrophysiological characteristics of escaped rhythm—relative fixation of escape cycle and reorganization at any time.Its scatter plot is mainly featured by the fact that point set after premature beats or capture is overlapped in the dominant rhythm of constant velocity line,which is symmetrical distributed by premature beat point set and pre-premature-beat point set.Methods such as reverse technique and waterfall graphic analysis are usually utilized to judge atrioventricular relationship and identify properties of escaped rhythm.Two-dimensional Lorenz scatter plot is equivalent to the xOy and yOz plane of three-dimensional Lorenz scatter plot;two-dimensional difference scatter plot is equivalent to the xyz plane of three-dimensional Lorenz scatter plot with comparatively compact graphs which facilitates its illustration and understanding.The zOx plane is still symmetrically distributed along the constant velocity line.

关 键 词：时间散点图 三维Lorenz散点图 二维Lorenz散点图 差值散点图 二度Ⅰ型房室传导阻滞 二度Ⅱ型房室传导阻滞 三度房室传导阻滞 逸搏心律 节律重整 动态心电图 

分 类 号：R540.4[医药卫生—心血管疾病]