摘要
目的左心室肥大(LVH)的心电图诊断标准是一个较为复杂的问题,根据以往文献中推荐的方法,往往会产生较高的误诊或漏诊率。本文目的找出一个简化的特异性及敏感性都较高的单纯左心室肥大诊断指标。方法根据404例经B超、X线、临床体检确诊的左心室肥大病例的ECG表现,研究左心室肥大时的肢导联R波特点,评价RⅠ高度的诊断价值,从而确定出简化的诊断标准。结果结果表明,肢导联中R波增高的特异性较高,而敏感性各不相同,其中以RⅠ特异性最高,RⅡ次之,ST-T继发性改变多在较严重的肥大时发生,故其敏感性较低,而特异性亦不高,心电轴一项敏感性及特异性均较低。从诸多诊断指标中筛选出RⅠ>13mm,RV4-RV5≥25mm,ST呈下斜形压低几项指标做为新的诊断指标,并在临床上试用以了解其诊断符合率。其中、两项为必备条件,为辅助条件。结论经用以上标准对上述404例患者加以分析,结果是:诊断符合率为92.5%,敏感性为82.3%。根据本研究结果,我们建议对LVH的诊断标准加以简化,简化后的指标以RⅠ≥13mm、RV4-V6≥25mm为主,只要ECG中出现这两种改变,即可确立诊断,若再辅以心电轴轻度左偏>-5°及ST-T改变两项指标,则诊断符合率将会更高。
Objective Electrocardiogram diagnosisstandardabout LVHisa complex problem.Previous method of diagnosis recommended in the literature easily result in mis-diagnosis and missed-diagnosis.Objectives To find diagnosis standard simplified with higher sensitivity and specificity.Methods According to ECG manifestations of 404 LVH cases diagnosed by type-B ultrasonic,X-radiation and clinical examination,the paper analyses the characteristics of limb lead R wave,evaluates the value of diagnosing the height of RⅠ in order to determine diagnosis standard simplified.Results It is shown in result that the specificity of limb lead R wave growth is higher,while the sensitivity is varied,and the RⅠ is the most specific,RⅡ followed,the secondary change of ST-T occurs in more hypertrophy,so the sensitivity is low and the specificity is low too,the sensitivity and specificity of heart electrical axis are all lower.①RⅠ 13 mm,②RV4-RV5≥25 mm and ③downward sloping ST are selected from all standards as new diagnostic standards and tested in clinical trials.① and ② are necessary conditions,③ is secondary conditions.Conclusion Analysis and diagnosis of 404 cases mentioned above by the standards indicate that diagnostic accordance rate is 92.5% and sensitivity is 82.3%.According to above finding,we propose that the diagnostic standards for LVH should be simplified.RⅠ≥13 mm and RV4-V6 ≥25 mm are main standards.The diagnosis can be made as long as two changes appear in ECG.If main standards are coupled with cardiac electrical axis mild left-side -5° and ST-T changes,the diagnosis accordance rate will be higher.
出处
《中国现代药物应用》
2010年第18期12-13,共2页
Chinese Journal of Modern Drug Application
关键词
左心室肥大
诊断标准
特异性
敏感性
Left ventricle hypertrophy
Diagnosis standard
Specificity
Sensitivity
