CAJ | 학술논문

目的探讨P波时限及离散度在慢性充血性心力衰竭(CHF)并阵发性心房颤动患者的预测价值.方法对确诊65例患者采用12导联同步体表心电图记录(纸速50 mm/s),4次/月,记录的心电图取基线平稳,图形清晰的心动周期进行采样测量,12导联P波宽度测量后,取最大P波时限(Pmax及最小P波时限(Pmin),两者的差为P波离散度(Pd)(即Pd=Pmax-Pmin).以Pmax≥110 ms、Pd≥40 ms为阳性标准,随访1年,并对所有数据作统计学分析.结果患者阵发性心房颤动发作时,P波离散度(Pd)和Pmax明显增大(P<0.01),当患者心电图Pmax≥110 ms时,其预测充血性心力衰竭患者伴发心房颤动的灵敏度最高,但特异性却不如Pd≥40 ms及(Pmax≥110 ms)+(Pd≥40 ms),而且阳性预测值也明显低于后两者.其中以(Pmax≥110 ms)联合(Pd≥40 ms)的特异性和阳性预测值均最高.另外患者心房颤动发作前后左心房内径(LAD)和左心室射血分数(LVEF)变化有统计学意义(P<0.05).结论 Pmax联合Pd在CHF患者中并发心房颤动具有较高的预测价值.联合利用这两项指标来预测房性心律失常,特别是那些未被体表心电图证实的阵发性心房颤动患者,具有重要的临床意义.
목적 탐토P파시한급리산도재만성충혈성심력쇠갈(CHF)병진발성심방전동환자적예측개치.방법 대학진65례환자채용12도련동보체표심전도기록(지속50 mm/s),4차/월,기록적심전도취기선평은,도형청석적심동주기진행채양측량,12도련P파관도측량후,취최대P파시한(Pmax급최소P파시한(Pmin),량자적차위P파리산도(Pd)(즉Pd=Pmax-Pmin).이Pmax≥110 ms、Pd≥40 ms위양성표준,수방1년,병대소유수거작통계학분석.결과 환자진발성심방전동발작시,P파리산도(Pd)화Pmax명현증대(P<0.01),당환자심전도Pmax≥110 ms시,기예측충혈성심력쇠갈환자반발심방전동적령민도최고,단특이성각불여Pd≥40 ms급(Pmax≥110 ms)+(Pd≥40 ms),이차양성예측치야명현저우후량자.기중이(Pmax≥110 ms)연합(Pd≥40 ms)적특이성화양성예측치균최고.령외환자심방전동발작전후좌심방내경(LAD)화좌심실사혈분수(LVEF)변화유통계학의의(P<0.05).결론 Pmax연합Pd재CHF환자중병발심방전동구유교고적예측개치.연합이용저량항지표래예측방성심률실상,특별시나사미피체표심전도증실적진발성심방전동환자,구유중요적림상의의.
Objective To evaluate the predictive value of P-wave duration and dispersion and the chronic congestive heart failure in patients with paroxysmal atrial fibrillation. Methods 65 cases diagnosed in a 12-lead ECG synchronization surface records( paper speed of 50 ram/s) ,four times a month,records from the baseline ECG smooth, cleargraphics cardiac cycle sampling measurement. 12-P-wave width measurement, from the largest P-wave duration(Pmax)and the smallest P-wave duration(Pmin) , the P-wave dispersion is less PminPmax Pmax≥110 ms and Pd≥40 ms are as positive standards,in 1 year follow-up,and all datas are for statistical analysis. Results Attack patients with paroxysmal atrial fibrillation, Pd and Pmaxsignificantly increased (P< 0.01). And when patients with ECG Pmax≥110 ms, the sensitivity of the highest forecast the congestive heart failure with atrial fibrillation. However, specificity was nnt than Pd≥40 ms and(Pmax> 110 ms) + (Pd≥40 ms) , And the positive predictive value was significantly lower than the latter two also. To which( Pmax 110 ms) joint(Pd≥40 ms)of the specificity and positive predictive value were highest. Also before and after the onset of atrial fibrillation in patients with left atrial diameter(LAD) and left ventricular ejection fraction(LVEF) changes in the statistical significance(P<0.05). Conclusion Pmax joint Pd in CHF patients with atrial fibrillation have a higher predictive value. To use this 2 indicators to predict atrial arrhythmia,Especially those who have not been confirmed surface electrocardiogram in patients with paroxysmal atrial fibrillation, have important clinical significance.