右胸导联心电图诊断右室梗塞的价值综述

近年来右室梗塞(RVI)日益受到重视,为进一步掌握右胸导联心电图的诊断,本文将有关研究综述如下。 1 正常人右胸导联心电图 1.1 QRS波群 多数作者认为,正常成人右胸导联心电图有一定变化规律。即QRS呈rS型,以V_3R出现率最高,V_3R以右导联r波振幅依次递减或消失,S波振幅亦依次降低,QRS演变为qr或QS型。对于右胸导联Q波的研究,各家报导略有不同Andensen等强调正常人不应在全部右胸导联出现Q波,否则应疑及RVI;但有作者却认为,正常人V_3R—v_6R均可呈QS     

正常人肢体导联心电图与对应头胸导联心电图的比较

目的比较健康人常规12导联中的肢体导联心电图与相对应头胸导联正常心电图之间的差异。方法选择健康体检者同时记录常规心电图及头胸导联心电图,由两位资深的电生理医生分析,作出心电图无异常的诊断。而后以6个肢体导联（I、II、III和aVR、aVL、aVF）分别与头胸导联中对应的各两组导联（CL2、CL4、CL6和HV7、HV8、HV9及HR3、HO、HL3和AR3、HR7、AL3）,进行逐一配对的心电图比较。观察心电图P、QRS、T波的形态,计数各导联同一波形之假性改变者,作对应导联的卡方检验进行比较。结果在120例健康人正常心电图中,常规肢体导联中的III导联双相或倒置P波的出现率是31.6%、宽或深Q波的出现率是29.1%、低平或倒置T波的出现率是26.7%,而对应头胸导联的CL6或HV9导联上述假性改变的出现率均为零（0.0%）;aVR导联P波和T波倒置的出现率是100%,而对应头胸导联AR3倒置P、T波的出现率均为18.3%,HR3导联无假性改变;aVL导联T波倒置的出现率是23.3%,而HO和HR7导联无假性改变。正常心电图P-QRS-T波假性改变在两导联系统的出现率有统计学上的差异（均为P<0.01）。结论健康人的正常心电图,头胸导联波形假性改变出现率比常规肢体导联显著降低。     

健康人右胸导联QRS波和T波形态分析

目的探讨健康人右胸导联心电图QRS波和T波形态及临床意义。方法测量867名健康人右胸导联心电图,分析QRS波和T波形态。结果右胸导联Q波的发生率与V1导联R波的幅度有密切关系,V1呈QS型、V3R～V5R多数有Q波。V1呈rS型,则R波幅度越小,V3R～V5R出现Q波的机会越大;右胸导联V1→V3R→V5R直立T波出现逐渐减少,倒置T波出现逐渐增多。结论健康人右胸导联心电图V1、V3R～V5R出现Q波和T波倒置不能作为诊断合并右室心肌梗（RVMI）的可靠依据。     

HC导联QRS波心电轴测试方法探讨

Wilson' s导联 (常规导联 ) QRS波心电轴测量与应用对诊断心脏左右心室肥大、束支传导阻滞等提供了有价值的诊断依据。头胸导联 ( HC)导联作为一种新型的导联系统 ,没有一种完整系统的心轴测试方法。我们根据尹炳生提出的拟球状面波陈传递假说利用 HC导联系统的 HL3,HR3导联测试 HC导联系统 QRS波心电轴 ,并以此探讨 HC导联心电轴测试方法。对象与方法随机选择我院门诊与住院患者 5 9例 ,年龄 19～ 81岁。平均年龄 4 3 .3岁 ,采用日本 65 11单导心电图机在同一部位作同步记录常规导联与 HC导联心电图。纸速 2 5 mm/ s,定标电压 10m…     

从正常人胸表心电位场电势分布看瞬间心电向量的综合

目的探讨正常人瞬间心电向量综合的可能性。方法选择健康体检者同步记录Wilson导联（V1-V6）及其扩展导联（V7-V9、V3R—V9R）和对应头胸导联（HV1～HV9、HV3R—HV9R）的心电图。以环绕胸部一周16个测试点记录的心电图QRS波形态来描绘胸表心电位场电势分布,并以此判断瞬间心电向量的综合情况。结果120例正常人中Wilson右胸导联V4R～V9R QRS波均为主波倒置的宽／深Q波;而对应头胸导联HV4R～HV9R记录到主波正立的rs、RS或qRs波;其余各测试点两导联均记录到明显正立的R（r）波。头胸导联记录的QRS波胸表心电位场电势均呈一致向外分布的现象,与瞬间心电向量综合的结果不符;Wilson导联则均呈大致左胸正、右胸负的偶极分布,似与瞬间心电向量综合的结果相符,但左室前壁的V3、V4、V5导联心电图和左室正后壁V7、V8、V9导联心电图的R波正立且波形都很大,前后体表电位无偶极分布现象,与左室前后壁瞬间心电向量综合的结果相矛盾。结论正常人胸表心电位场的电势分布表明瞬间心电向量综合的可能性存在疑问。     

67例中老年正常人V_4R与HV_4R导联QRS形态对比分析

心电图是诊断右室梗死(RMI)的重要手段之一,而常用Wilson V_(2-5)R导联,尤其正常老年人在该导联亦能出现Q波,为进一步排除非病理性Q波,我们对Wilson V_4R与HV_4R(头胸导联)的QRS波形态加以对比分析。     

新西兰兔实验性高侧壁心肌坏死的Wilson和头胸导联的定位诊断

目的：比较新西兰兔实验性高侧壁心肌坏死Wilson和头胸（HC）导联的定位诊断。方法：采用冰乙酸化学腐蚀法复制高侧壁心肌坏死的动态模型30只，记录心表心电图（ECG）加以确认，再记录胸背体表70点的ECG。根据病理性Q波出现和分布范围的不同，判断两种导联定位诊断的差异。结果：Wilson导联胸背部区都记录到病理性Q波，而HC导联仅在胸部小范围记录到病理性Q波，统计同一测试点两种导联记录的病理性Q波的倒数，经x^2检验（P＜0．05），有显性差异，结论：病理性Q波的出现区域Wilson导联无于HC导联，HC导联对实验对高侧壁心肌坏死的定位诊断优于Wilson导联。     

V1与V3R～V6R导联QRS波群相关性分析

目的探讨右胸导联正常QRS波群的内在规律。方法观察220例健康大学生常规12导联和V3R-V6R导联心电图，分析V1QRS波群呈不同形态时V3R-V6R导联QRS形态和q波时间、电压及q／R比值。结果V3R-V6R与V1QRS形态相似率逐导联降低；V3R-V6Rq及Qs波出现率逐导联增高（1．82％、6．82％、23．64％、47．27％）；V1呈Rs时V3R、V4R无q或QS波，V1呈QS时V3R、V4R均呈QS型；V3R、V4R或V5R出现q或QS波，则其右侧导联也出现q或QS波（即不会单个导联出现q或QS波）；V3R-V6Rq波时间〈0．04s，q／R比值可〉1／4。结论正常人右胸导联可出现q或QS波，孤立导联的q或QS波有临床意义。     

健康青年右胸头胸导联心电图和常规导联心电图对比分析

目的 :对比观察头胸导联心电图和常规导联心电图反映右室心电活动的差异。方法 :对 5 0例健康青年进行右胸头胸导联和常规导联 2种心电图的检查 ,并对 P波、QRS波、T波进行对比。结果 :右胸头胸导联心电图 P波、R波、直立 T波较常规导联对应的各波波幅明显增大。而前者的 Q波及部分 S波波幅较后者明显减小。右胸头胸导联心电图未见宽深 Q波和倒置 T波。结论 :头胸导联心电图较常规导联心电图更好地反映右室的心电活动     

新西兰兔实验性高前壁心肌坏死的Wilson和头胸导联的定位诊断

目的：比较新西兰兔实验性高前壁心肌坏死Wilson和头胸（head-chest,HC)导联的定位诊断。方法：采用冰乙酸化学腐蚀法复制高前壁心肌坏死的动物模型30只，记录心表心电图加以确认，再记录胸痛体表70点的ECG。根据病理性Q波出现和分布范围的不同，判断两种导联定位诊断的差异。结果：Wilson导联在胸痛部区域都记录到病理性Q波，而HC导联仅在胸部小范围内记录到病理性Q波，同一测试点两种导联记录到的病理性Q波的例数，经配对计数资料的x^2检验有显性差异（P＜0．05），同一试点H导联病Q波阳性率显少于Wilson导联。结论：Wilson导联记录到病理Q波的范围过于广泛，而HC导联则相对集中，与心肌坏死区域相当，故HC导联对于高前壁心肌坏死定位诊断的价值优于Wilson导联。     

Pacemaker leads

Present day pacemaker leads are far superior in every respect to those of the past. Modification of fixation characteristics has reduced displacement rates to 1% or less in most centers. Fracture of multifilar leads is a rarity. Biodegradation of polyurethane insulation appears to be an isolated problem specific to individual lead models and may be related to physical stresses incurred during manufacture or lead insertion. Recent evidence has incriminated an interaction of polyurethane with silver which arises from the drawn braised strand conductor substrate of those leads in which this problem has been noted. This may explain why the problem has been restricted to specific lead models of one manufacturer to date. Lack of uniformity of lead terminal size between manufacturers and even within the same manufacturer's product line continues to baffle this observer. Although past problems of lead displacement have been markedly reduced, the difficulty of removing chronic leads which have become septic appears to have worsened. Modification of existing leads to ensure that the interface between electrode tip and proximal shaft is unidiametric is essential.     

EASI 3导联衍生的12导联心电图的应用研究

目的在亚洲人群中导出EASI导联和常规12导联心电图的转换系数和方程,比较亚洲人群与北美人群之间导联转换上的差异性,同时观察导联转换是否受年龄、性别、身高和体重的影响。方法627例受试者同步记录常规12导联心电图和EASI导联心电图。同时记录年龄、性别、身高和体重。结论在亚洲人群和北美人群之间,导联转换无显著性差异,年龄、性别、身高和体重对导联转换无显著影响。     

The relation of unipolar limb leads to precordial and esophageal leads

Multiple semidirect leads from the thorax and esophagus along with the augmented unipolar limb leads were obtained in normal subjects in the recumbent and erect postures during quiet breathing and sometimes during forced expiration and full inspiration as well. If a sufficient number of semidirect leads were taken, the counterpart of the QRS-T pattern of each of the unipolar limb leads could be demonstrated in a precordial or esophageal lead and a pathway along which the QRS-T complex maintained a fairly uniform configuration could be found bridging the gap between the extremity and the point on the thorax near the heart where the corresponding semidirect lead was obtained. From the anatomic position of the corresponding semidirect lead and of the pathway leading into the extremity, it was concluded that the potential variations of a given extremity are dominated by those of the epicardial surface which faces toward that extremity.The findings are presented graphically for five subjects, who were selected as collectively illustrative of the normal variations in QRS-T pattern in unipolar limb leads. The illustrations include the marked variations which may be produced by postural or respiratory shifts in cardiac position. The QRS-T pattern in each of the unipolar limb leads was classified in accordance with the corresponding semidirect lead.The findings in Lead aV_L were classified into the five basic patterns: (1) QRS-T resembling that in semidirect leads over the anterolateral aspect of the left ventricle (Leads V₅ and V₆) and characterized by a prominent R with or without a small Q and/or S, preceded by an upright P and followed by an upright T; (2) QRS-T resembling that in semidirect leads over the anterior aspect of the right ventricle (Leads V₁ and V₂) and characterized by a small R₁ relatively deep S, and by a T wave which is usually upright, but occasionally flattened or shallowly inverted; (3) QRS-T resembling that in precordial leads at the transitional zone (generally Lead V₃) and characterized by a QRS of low voltage, consisting of two or more phases of approximately equal amplitude; (4) QRS-T resembling that in esophageal leads opposite the posterior aspect of the left ventricle and characterized by a relatively small Q and tall R preceded by an inverted P wave and followed by an upright, flattened, or inverted T; and (5) QRS-T resembling that in esophageal leads from behind or above the left atrium and characterized by a relatively deep and prolonged Q and small late R, preceded by an inverted P and followed by an inverted T.The findings in Lead aV_F usually corresponded fairly closely with those in leads from the lower esophagus and stomach and were classifiable into four basic patterns: (a) QRS-T resembling that in precordial leads over the right ventricle (Leads V₁ and V₂) which was associated with Pattern 1 in aV_L as a manifestation of counterclockwise rotation into a horizontal position; (b) QRS-T resembling that in leads at the transitional zone, which was also associated with Pattern 1 in aV_L as a manifestation of less counterclockwise rotation into a semihorizontal position; (c) QRS-T resembling that in leads from the apical portion of the left ventricle (Leads V₅ and V₆ and lower esophageal leads) which might be found in association with any of the five patterns in Lead aV_L, depending upon the degree of rotation on the anteroposterior, longitudinal, and transverse axes into an intermediate, semivertical, or vertical position; and (d) QRS-T resembling that in esophageal leads opposite the posterobasal aspect of the left ventricle, characterized by a distinct Q, tall R, isoelectric to slightly depressed RS-T, inverted, diphasic, or flattened T, and accompanied by Patterns 2 or 5 in Lead aV_L, depending mainly upon the rotation on the longitudinal axis.While the pattern in Leads aV_L and aV_F is subject to marked variation due to the mobility of the ventricles in the left chest, the pattern in Lead aV_R is more uniform due to the fixation of the base of the heart, which faces toward the right arm, by the attachments to the great vessels. The major deflection of ventricular origin in Lead aV_R is derived from the potential variations of the endocardial surfaces and cavities of the two ventricles and consists of a downward QRS and inverted T wave. Minor variations may occur in Lead aV_R, consisting of either or both of the following: (1) a minute initial R transmitted from the epicardial surface of the right ventricle across the anterior chest wall; or (2) a late R which tends to be transmitted from the posterobasal surface of the left ventricle across the posterior chest wall when the heart is rotated backward on a transverse axis.The standard limb leads have been analyzed in terms of unipolar limb leads. If unipolar limb leads and multiple precordial leads are available, standard leads are superfluous, since they contribute no information that cannot be derived more precisely from the unipolar limb leads, studied in conjunction with multiple precordial leads.