动态心电图对房颤合并Ⅱ度房室传导阻滞的诊断分析  

A diagnostic analysis on dynamic ECG for Ⅱ° AVB in patients with atrial fibrillation

作　　者：李宜富 陈永久[1] 姜昕[1] 吴盛标[1] 董少红[1] 

机构地区：[1]深圳市人民医院心内科,518020

出　　处：《实用心脑肺血管病杂志》2004年第1期7-9,共3页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的　探讨合适的心房颤动 (AF)合并Ⅱ度房室传导阻滞 (Ⅱ°AVB)的诊断标准。　方法　记录 6 7例AF病人的 2 4小时心电图。　结果　 (1) 5 8例病人发生 >1 5秒的长R -R间歇 ,平均最长R -R为 2 30秒± 0 5 3秒 ,多数发生在夜间 (占 84 91% ) ;(2 )平均心室率为 80 95次 分± 15 17次 分 ,发生长间歇病人的平均心室率为76 2 5次 分± 5 32次 分 ;(3) 10例转复为窦性心律 ,无一例存在Ⅱ°AVB ,仅 1例P -R延长至 0 2 2秒 ;(4)分别以长间歇≥ 1 5秒、平均心室率≤ 6 0次 分、逸搏占总心跳百分比≥ 0 1%作为诊断标准 ,其诊断阳性率分别为 86 75 %、2 99%、2 98%。　结论　AF时发生 1 5秒以上的长间歇很常见 ,单以长间歇≥ 1 5秒诊断AF合并Ⅱ°AVB易造成误诊 ,应结合平均心室率。Objective To search proper standards to diagnose atrial fibrillation(AF) with the second degree atrial ventricular block(Ⅱ°AVB) Methods To record 24 hours ECG for 67 patients with AF Results (1)Fifty eight patients had long R R intervals,the mean of the longest R R intervals was 2 30s±0 53s,most of them took place at night(84 91%);(2)The mean of patients' heart rate was 80 95±15 17 beats/min,that of patients with long R R was 76 25±5 32 beats/min;(3)Ten patients were converted to sinus rhythm from AF,none of them presented Ⅱ°AVB,only one patient had abnormal ECG that P R interval was prolonged to 0 22s;(4)According to the standards that R R interval ≥1 5s,the mean heart rate≤60beats/min,and the percentage of escape beats ≥0 1% over general beats,the positive percentage of the diagnosis was 86 57%,2 99%,2 98% Conclusion It might cause a misdiagnosis of AF with Ⅱ°AVB if the long R R interval were adopted as the only standard,so,we should consider other standards such as mean heart rate and the percentage of escape beats over general beats etc

关 键 词：动态心电图 Ⅱ度房室传导阻滞 心房颤动 合并症 诊断标准 

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