头胸导联与常规Wilson导联对异常Q波诊断的对比研究

目的观察头胸导联和常规导联异常Q波出现的规律与内在联系.方法常规心电图存在异常Q波患者124例,其中心肌梗死40例,合并心室肥大42例以及A型预激综合征42例.比较以上患者Wilson导联和头胸导联异常Q波的分布情况.结果头胸导联和Wilson导联的异常Q波存在一定的对应关系.头胸导联对右室梗死、后壁梗死的诊断优于常规导联;左心室肥大和前壁心肌梗死均可在V1-V3导联出现异常Q波,当头胸导联HV3R-HV8R同时存在异常Q波时为前壁心肌梗死,无异常Q波则为左心室肥大所致;头胸导联对A型预激综合征的旁道定位诊断,要结合常规导联才能准确地判断是左前游离壁、左前侧壁房室旁道.而在左后间隔房室旁道的定位上不及常规导联有意义.结论头胸导联对右室和后壁梗死的诊断以及鉴定异常Q波的来源具有重要价值,对A型预激综合征的定位诊断有一定价值.

The diagnostic value of head-chest lead and Wilson lead for abnormal Q wave

Objective The diagnostic value of head-chest lead and Wilson lead electrocardiography(ECG) for abnormal Q wave was evaluated.Methods One hundred and twenty-four patients with abnormal Q wave of Wilson lead were studied,including 40 cases of myocardial infarction,42 cases of ventricular hypertrophy and 42 cases of A type preexcitation syndrome.The distribution of abnormal Q waves for head-chest ECG and Wilson lead ECG was analyzed.Rrsults There was a corresponding relationship between abnormal Q waves of head-chest lead and Wilson lead.The diagnostic value of head-chest lead ECG for right ventricular hypertrophy and posterior wall myocardial infarction was better than that of Wilson lead ECG.Both patients with left ventricular hypertrophy and anterior wall myocardial infarction had abnormal Q waves in V 1-V 3 leads of Wilson lead ECG,whereas abnormal Q waves in HV 3R -HV 8R leads of head-chest lead ECG were found in patients with anterior wall myocardial infarction,but were not seen in patient with left ventricular hypertrophy.Head-chest lead ECG combined with Wilson lead ECG was useful for the pathway localization of A type preexcitation syndrome ,the localization diagnosis of Wilson lead ECG,but the localization diagnosis of Wilson lead ECG for left posterior septal pathway was more helpful.Conclusion Head-chest lead ECG is very useful for the diagnosis of right ventricular and posterior wall myocardial infarction as well as the origin of abnormal Q waves,but is only a little helpful for the pathway localization of A type preescitation syndrome.