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目的探讨下壁导联R波切迹与儿童房间隔缺损程度的相关性。方法对197例继发孔型房间隔缺损(ASD)患儿(缺损组)的手术前后常规心电图及超声心动图检查结果进行回顾性分析,按缺损程度不同随机分为三组,小型组(缺损小于5mm)68例,中型组(缺损5~10mm)76例,大型组(缺损大于10mm)53例;同期观察183例体检无心脏疾病的正常儿童作为对照组。结果①缺损组129例患儿心电图下壁导联出现R波切迹,单个导联38例,两个导联42例,三个导联49例;对照组心电图下壁导联出现R波切迹者29例,单个导联16例,两个导联9例,三个导联4例;两组差异有统计学意义(P<0.05)。②小型组37例患儿心电图下壁导联出现R波切迹,单个导联者28例,两个导联者7例,三个导联者2例。中型组52例患儿出现R波切迹,单个导联者7例,两个导联者29例,三个导联者16例。大型组40例患儿出现R波切迹,单个导联者3例,两个导联者6例,三个导联者31例。三组间比较有统计学意义(P<0.05)。③缺损组三组切迹总例数相比,小型组与中型组及中型组与大型组相比无统计学意义(P>0.05);小型组与大型组相比有统计学意义(P<0.05)。④缺损患儿手术后15、30d下壁导联R波切迹消失三组间对比有统计学意义(P<0.05)。结论房间隔缺损患儿缺损程度越大,导致右冠供血对应下壁导联心电图R波切迹数目越多,同时随着术后恢复时间延长R波切迹消失;表明R波切迹为ASD患儿独立特征性的心电图改变,为临床早期发现并判断缺损程度提供了一种简单无创方法。
Objective To investigate the relationship between the inferior wall lead R wave notch and the degree of atrial septal defect in children. Methods The results of routine electrocardiogram and echocardiography in 197 children with ASD (defect group) before and after surgery were retrospectively analyzed. According to the degree of defect, they were randomly divided into three groups. Small group (defect (Less than 5 mm in 68 cases), mid-sized group (5 to 10 mm in defect), and 53 in large group (more than 10 mm in defect). In the same period, 183 normal children without physical heart disease were observed as control group. Results ① In the defect group, R wave notch was observed in the inferior leads of 129 cases of ECG. There were 38 cases of single leads, 42 cases of two leads and 49 cases of three leads. In the control group, There were 29 cases with single lead in 16 cases, two leads in 9 cases and three leads in 4 cases. The difference between the two groups was statistically significant (P <0.05). ② In 37 cases of small group, R wave notch was observed on the inferior wall leads of ECG, including 28 cases of single lead, 7 cases of two leads and 2 cases of three leads. In the middle group, 52 children had R wave notch. There were 7 cases with single lead, 29 cases with two leads and 16 cases with three leads. R wave notches were observed in 40 cases in the large group, with 3 cases of single lead, 6 cases of two leads and 31 cases of three leads. The three groups were statistically significant (P <0.05). (3) There was no significant difference in the number of notch between the three groups in the defect group (P> 0.05), but the difference between the small group and the large group was statistically significant (P < 0.05). ④ There was significant difference between the three groups (P <0.05). Conclusion The greater the degree of defect in children with atrial septal defect, leading to the lower right coronary artery lead ECG wave R wave notch more number, and with the extension of postoperative recovery time R wave notch disappears; R wave notch is independent of ASD children The characteristic ECG changes provide a simple and non-invasive method for early detection and judgment of the degree of defect.