三种宽QRS波心动过速鉴别流程的对比研究  

A comparative study on three different diagnostic procedures for wide QRS complex tachycardia

作　　者：聂文娟 杨平花 陈云博 冯应君 Niewenjuan;Yang pinghua;Chen yunbo;Feng yingjun(Yue Bei People's Hospital,Guangdong,512026,China;The First People's Hospital of Zunyi,Guizhou,563000,China;Sir Run Run Shaw Hospital,Zhejiang,310016,China)

机构地区：[1]汕头大学附属粤北人民医院,512026 [2]贵州省遵义市第一人民医院,563000 [3]浙江大学医学院附属邵逸夫医院,310016

出　　处：《临床心电学杂志》2021年第2期95-99,共5页Journal of Clinical Electrocardiology

摘　　要：目的探讨a VR单导联四步法、室速积分法、肢体导联流程(LLA)诊断宽QRS心动过速的临床价值。方法选取41例宽QRS心动过速患者发作时的体表12导联心电图,并经心内电生理检查证实心动过速性质,由两位心电图医师分别用三种鉴别流程进行诊断,对比三种方法诊断室速(VT)的敏感度、特异度、准确性、约登指数及一致性。结果a VR单导联四步法诊断VT的准确性为80.5%,室速积分法为48.8%,LLA为78.1%;敏感度分别为87.9%、42.4%、78.8%;特异度分别为50.0%、75.0%、75.0%;约登指数分别是37.89%、17.4%、53.8%。a VR单导联四步法的Kappa值为0.485,室速积分法的Kappa值为0.015,LLA的Kappa值为0.662。结论a VR单导联四步法的准确性及敏感度高于LLA及室速积分法。LLA的约登指数高于a VR单导联四步法及室速积分法。LLA与室速积分法的特异度一致,高于a VR单导联四步法。两位医师诊断结果一致性较好的是LLA,其次为a VR单导联四步法,最差的为室速积分法。三种鉴别流程各有优缺点,在临床实践中可扬长避短,综合运用。Objective To investigate the clinical value of three ECG algorithms for the differentiation diagnosis of wide QRS complex tachycardia(WCT).These three algorithms included a VR single lead four step method(short named as a VR-lead method),ventricular tachycardia score(short named as VT-score method)and limb lead algorithm(LLA).Methods Twelve-lead electrocardiogram(ECG)was selected from 41 patients with WCT.The nature of the tachycardia was confirmed by intracardiac electrophysiology.The diagnosis was made by two experts in ECG diagnosis using these three diagnostic procedures.The sensitivity,specificity,accuracy,Youden index and consistency of the three methods were compared.Results The accuracy of the a VR-lead method,the VT-score method,and the LLA in the diagnosis of VT was 80.5%,48.8%,and 78.1%.The sensitivity was 87.9%,42.4%,and78.8%;the specificity was 50.0%,75.0%,and 75.0%;and the Youden index was 37.89%,17.4%,and 53.8%.The kappa value of the a VR-lead method,VT-score method,and LLA was 0.485,0.015,and 0.662,respectively.Conclusions The accuracy and sensitivity of a VR-lead method were higher than those of LLA and VT-score method.The Youden index of LLA was higher than those of a VR-lead method and VT-score method.The specificity of LLA was consistent with that of VT-score method,which was higher than that of a VR-lead method.Between the two experts,LLA was the most consistent,followed by a VR-lead method,and then the VT-score method.The three identification methods have their own advantages and disadvantages,which can be used together in clinical practice.

关 键 词：宽QRS心动过速 心电图 流程图 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]