宽QRS波相关的量化指标在心房颤动合并宽QRS波鉴别中的应用价值  

Application value of quantitative indicators related to wide QRS complex in the differentiation of atrial fibrillation with wide QRS complex

作　　者：余小佳 陈耀峰 兀花妮 谭仕芸 邓丽丽 Yu Xiaojia;Chen Yaofeng;Wu Huani;Tan Shiyun;Deng Lili(Electrocardiogram Room,Ankang People's Hospital,Ankang 725000,Shaanxi Province,China;Department of Cardiology,Ankang People's Hospital,Ankang 725000,Shaanxi Province,China)

机构地区：[1]安康市人民医院心电图室,安康725000 [2]安康市人民医院心内科,安康725000

出　　处：《中国基层医药》2025年第2期184-189,共6页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨宽QRS波相关的量化指标在心房颤动(房颤)合并宽QRS波诊断中的实用性和临床意义。方法采用回顾性研究, 选取安康市人民医院2021年1月至2023年12月就诊的患者93例的动态心电图数据进行分析。依据心律失常类别分为两组, 合并有室性早搏的房颤65例为房早组, 合并室内传导异常的房颤28例为房差组。比较两组传统鉴别指标及新量化指标, 分析新增量化指标对房颤合并宽QRS波识别的临床意义。结果两组蝉联现象、QRS波时限 > 140 ms、V1导联QRS波形态、V1导联R波或qR或R > r或rS最深处 > 60 ms、V6导联R/S < 1或者呈QS、aVR导联QRS波起始有顿挫或下降比较慢或呈大R、aVR导联Vi/Vt ≤ 1、无人区电轴的数据等差异均有统计学意义(χ^(2)=11.83、37.59、26.05、27.33、5.30、49.46、34.95、4.90, 均P < 0.05)。房早组的前间期/联律间期(1.38±0.32)低于房差组(1.84±0.43), 类代偿间期/联律间期(1.71±0.36)、类代偿间期/前间期(1.28±0.25)均高于房差组[(1.31±0.21)、(1.01±0.20)], 差异均有统计学意义(t=-5.71、5.48、5.06, 均P < 0.001)。前间期/联律间期、类代偿间期/联律间期、类代偿间期/前间期、3个指标联合(logistic回归方式联合)对房颤伴宽QRS波鉴别的曲线下面积分别为0.810、0.788、0.818、0.953, 其中3个指标联合的曲线下面积均明显高于其他单独的指标(Z=-3.10、-3.92、-3.09, 均P < 0.05)。结论前间期/联律间期、类代偿间期/联律间期、类代偿间期/前间期在房颤合并宽QRS波的诊断中展现出良好的价值, 三者的联合应用可显著提升诊断的精确度。Objective:To investigate the practicality and clinical significance of quantitative indicators related to wide QRS complex in the diagnosis of atrial fibrillation(AF)with wide QRS complex.Methods:A retrospective study was conducted to analyze the dynamic electrocardiogram data of 93 patients who visited Ankang People's Hospital from January 2021 to December 2023.Based on the type of arrhythmia,the patients were divided into two groups:AF with premature ventricular contraction(PVC)group(n=65)and AF with intraventricular conduction abnormality group(n=28).The traditional diagnostic indicators and newly introduced quantitative indicators were compared between the two groups to analyze the clinical significance of the new quantitative indicators in identifying AF with wide QRS complex.Results:There were statistically significant differences in the occurrence of cannon waves,QRS duration>140 ms,QRS morphology in lead V1,the R wave or qR pattern,or the deepest point of R being greater than r or rS in lead V1 being>60 ms,R/S ratio in lead V6<1 or displaying QS pattern,the presence of a notching,a slow decline,or a prominent R wave in the QRS beginning in lead aVR,Vi/Vt in lead aVR≤1,and the data regarding the electrical axis in the no man's land between the two groups(χ^(2)=11.83,37.59,26.05,27.33,5.30,49.46,34.95,4.90,all P<0.05).The premature interval/coupling interval in the AF with PVC group was(1.38±0.32),which was significantly lower than(1.84±0.43)in the AF with intraventricular condection abnormality group(t=-5.71,P<0.001).The quasi-compensatory pause/coupling interval and quasi-compensatory pause/premature interval in the AF with PVC group were(1.71±0.36)and(1.28±0.25),respectively,which were significantly higher than those in the AF with intraventricular conduction abnormality group(t=5.48,5.06,both P<0.001).The areas under the curve for the premature interval/coupling interval,quasi-compensatory pause/coupling interval,and quasi-compensatory pause/premature interval,and the combined three indicators(us

关 键 词：心律失常 心性 心房颤动 心电描记术 便携式 室性早搏复合征 预激综合征 量化构效关系 

分 类 号：R541.75[医药卫生—心血管疾病]