扩张性心肌病心电图表现与临床意义探讨.doc

扩张性心肌病心电图表现与临床意义探讨 　　作者：王五一 作者单位：福建省立医院心电诊断科，福建医科大学省立临床医学院，福建 福州　350001 　　【摘要】 目的：探讨心电图对扩张性心肌病(DCM)的诊断及预后的价值。方法：分析83例DCM病人和86例健康体检者心电图，分析参数包括QRS时限，RV5电压，异常QRS波切迹，异常Q波，心律失常，及ST-T改变。83例扩心病人按QRS时限分为A组(41例，QRS时限0.10秒)、B组(14例，0.10秒0.12秒)，比较各组纽约心脏病学会(NYHA)分级情况及左、右室内径差异。结果：与健康体检者比较，DCM病人QRS时限明显增宽[(0.086±0.02)比(0.119±0.04)]，RV5电压明显减低[(1.58±0.51)比(1.08±0.72)]，异常QRS波切迹(5.8%比54.1%)、异常Q波(1.4%比23%)、心律失常(2.9%比67.2%)及ST-T改变(7.2%比100%)发生率明显增加(P0.05～0.01)。DCM患者A、B、C组中，心功能II级，C组显著少于A组(20.0%比48.1%)，左室舒张内径C组显著大于A组[(7.03±0.67)mm比(5.68±0.58)mm，P0.05]。结论：扩心病患者心电图有显著改变，QRS时限与心功能及左室内径有一定关系，对临床诊断有一定参考价值。 　　【关键词】 心肌病,扩张型,心电描记术,心功能，左室 　　Abstract：Objective： To investigate value of electrocardiogram (ECG) in diagnosis and prognosis of dilated cardiomyopathy (DCM). Methods：Analyses were performed on ECG of 83 DCM patients and 86 healthy subjects. A total of 83 DCM patients were divided into group A(n=41，QRS duration 0.10 s)，group B(n=14,0.10 s0.12 s) according to QRS duration. New York heart association (NYHA) cardiac function classifications and left and right ventricular diameters were compared among three groups. Results：Compared with healthy subjects，there were significant decrease in RV5 voltage [(1.58±0.51) vs. (1.08±0.72)]，and significant increase in QRS duration [(0.086±0.02) vs. (0.119±0.04)]，incidence rates of abnormal notches of QRS wave (5.8% vs. 54.1%)，abnormal Q wave (1.4% vs. 23%)，arrhythmias (2.9% vs. 67.2%) and ST-T changes (7.2% vs. 100%) in DCM patients，P0.05～0.01. Among three groups of DCM，patients with NYHA cardiac function class Ⅱ in group C were significantly fewer than that of group A(20.0% vs.48.1%)，and left ventricular end-diastolic diameter of group C was significantly more than that of group A[(7.03±0.67) mm vs.(5.68±0.58) mm，P0.05]. Conclusion：There are obvious changes in electrocardiogram in patients with dilated cardiomyopathy. QRS duration may have certain relationship with cardiac function and left ventricular diameter and it possesses certain referen