动态心电图对体表心电图P-R间期延长的诊断价值

目的 探讨动态心电图对体表心电图P．R间期延长的诊断价值，分析P—R间期延长的临床意义和预后。方法选择2008年1月至2011年8月在昆明医学院第二附属医院住院和门诊心电图有P-R间期延长的患者90例为研究对象．监测其动态心电图。分析P．R间期的变化及阵发性心房颤动、房室结双径路传导、第二度I型房室阻滞、间歇性左右束支阻滞4类心律失常。并且根据P—R间期延长程度分为3组，对比其与上述4类心律失常的关系。结果动态心动图结果中伴发第二度I型房室阻滞2l例（23．33％）、房室结双径路传导17例（18．89％）、间歇性左右束支阻滞9例（10％）、阵发性心房颤动7例（7．78％）。在所有的患者中，P．R间期延长伴发上述4类心律失常发生率为60％。心电图结果中，P-R间期延长50例，显著延长29例，过度延长11例。动态心动图结果中。P。R间期延长32例，显著延长38例，过度延长20例。结论P—R间期延长不应均视为良性和无须干预的心律失常，相反，需要进行进一步动态心动图监测及电生理检查和追踪观察，争取早期发现病变、消除病变，为临床早期诊断、早期治疗提供辅助手段。

Diagnosis value of dynamic electrocardiogram on P-R interval extension in electrocardiography

Objectives To study the diagnosis value of dynamic electrocardiogram （DCG） on P-R interval extension in electrocardiography （ECG）, and analyze the clinical significance and prognosis of P-R interval extension. Methods We selected 90 patients with P-R interval extension in ECG in The Second Affiliated Hospital of Kunming Medical College from January 2008 to August 2011 in this study. Meanwhile, we monitored their DCG to analyze the variation of P-R interval extension and four types of arrhythmia： paroxysmal atrial fibrillation, dual atrioventricular nodal pathways conduction, second degree I atrioventricular block, intermittent left and right bundle branch block. In addition, we established three groups according to the degree of P-R interval extension, and tried to compare them with the four types of arrhythmia. Results It was clear that there were 21 cases （23.33%） of DCG with second degree I atrioventricular block, 17 cases （ 18.89% ） with dual atrioventricular nodal pathways conduction, 9 cases （ 10% ） with intermittent left bundle branch block and 7 cases （7.78%） with paroxysmal atrial fibrillation. Of all the cases, the incidence of P-R interval extension associated with the four types of arrhythmia was 60%. There were 50 cases with P-R interval extension in ECG, with 29 cases of obvious extension and 11 cases of excessive extension; while there were 32 cases with PR interval extension in DCG, with 38 cases of obvious extension and 20 cases of excessive extension. Conclusions P-R interval extension should not be considered as benign. It should be considered as a kind of arrhythmia which need to be intervened. DCG should be monitored, examined and observed more, in order to find and eliminate lesions in the early stage, and provide some auxiliary means for early diagnosis and treatment.