单导联对宽QRS波鉴别诊断价值的应用

目的 验证应用Ⅱ导联QRS波第1峰时限(RWPT)、aVR导联形态及Vi/Vt比值对宽QRS波的鉴别诊断价值。方法 回顾性分析已明确诊断的261例室性早搏及127例房性早搏伴心室内差异传导患者12导联体表心电图的Ⅱ导联RWPT、aVR导联形态及Vi/Vt比值,比较3种方法鉴别诊断宽QRS波形早搏的敏感度、特异度、阳性预测值、阴性预测值、准确度,并比较aVR导联形态法前3步的鉴别价值。结果 ①Ⅱ导联RWPT、aVR导联形态法鉴别宽QRS波差异无统计学意义(P>0.05),均有较高的准确度、敏感度、特异度、阳性预测值;Vi/Vt比值法与其余两种方法相比准确度、敏感度较低(P<0.05),特异度、阳性预测值较高(P<005)。②应用aVR导联形态法第1步、第3步有较高的特异度,第3步有较高的阳性预测值。结论 鉴别诊断宽QRS波时,Ⅱ导联RWPT、aVR导联形态法较Vi/Vt比值法诊断价值高,且具有简便、快捷、准确的优点。

Application of single lead on the diagnosis of wide QRS complex

Objective To verify the values of R-wave peak time(RWPT) inⅡlead,form of aVR lead and ratio of Vi to Vt in the differential diagnosis of wide QRS complex. Methods By12-lead electrocardiograms of 261 patients specifically diagnosed with premature ventricualr contraction and 127 cases with atrial premature beats complicated with intraventricular aberrant conduction,their RWPT in Ⅱlead,forms of aVR lead and values of Vi / Vt were retrospectively analyzed. The sensitivity,specificity,positive and negative predictive values and accuracy of the above three methods in the differential diagnosis of wide QRS complex were compared. The identification value of the first three steps of aVR lead form method was also compared. Results ① In the identification of wide QRS complex,differences between the methods of RWPT inⅡlead and form of aVR lead weren’t statistically significant(P > 0. 05) and the two methods shared the same accuracy,sensitivity,specificity and positive predictive value. Compared with the other two methods,accuracy and sensitivity of Vi / Vt ratio method were lower(P < 0. 05) while specificity and positive predictive value were higher(P > 0. 05). ② With the application of aVR lead form method,the first and the third step had relatively higher specificity and the third step had relatively higher positive predictive value. Conclusion The methods of RWPT inⅡlead and form of AVR lead were simple,convenient and accurate in the differential diagnosis of wide QRS complex,owning superiority over Vi / Vt ratio method.