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目的:为评价形态心电图单项标准、多项组合的Brugada标准及Brugada标准联合Steurer标准在宽QRS波心动过速(WRT)鉴别诊断中的应用价值及存在的缺陷。方法:对112例WRT[室性心动过速(VT)64例,室上性心动过速(SVT)48例]发作时的常规12导联心电图进行分析。结果:形态心电图单项标准诊断VT的敏感性不高,但部分单项标准的特异性很强(100%),一旦出现,强烈提示VT;多项组合的Brugada标准可提高VT诊断的敏感性(93.8%)及准确性(86.6%),但特异性较低(77.1%);Brugada标准联合Steurer标准可进一步提高诊断VT的特异性(89.6%)及准确性(92.0%)。进一步分析显示:Brugada标准对器质性原因所致VT、右束支传导阻滞型(RBBB)特发性VT(IVT)、SVT伴室内差异性传导(AC)或原有单侧束支传导阻滞(BBB)者诊断符合率高(96.3%~100.0%);对左束支传导阻滞型(LBBB)特发性VT、SVT伴原有双支阻滞、心肌坏死或心肌梗死伴宽QRS波SVT及预激综合征(WPW)伴旁道前传型SVT(WPW-SVT)诊断的符合率低(0~57.1%)。联合Steurer标准可使WPW-SVT得以明确诊断,但对前三者无鉴别意义,故不适合在前三者中应用。结论:形态心电图单项标准诊断VT的敏感性较低,不能依赖某一单项标准判断VT,多项组合的Brugada标准联合Steurer标准是目前诊断VT敏感性、特异性、准确性较强的方法。
OBJECTIVE: To evaluate the value and limitations of morphologic electrocardiogram (ECG) single criteria, multiple combinations of Brugada criteria and Brugada standard combined with Steurer criteria in the differential diagnosis of wide QRS tachycardia (WRT). Methods: The routine 12 - lead electrocardiogram was analyzed in 112 patients with WRT [64 with ventricular tachycardia (VT) and 48 with supraventricular tachycardia (SVT)]. Results: The single electrocardiographic standard VT was not sensitive to the diagnosis of VT, but some of the individual criteria were highly specific (100%). VT was strongly suggested in the presence of a single standard. The combination of Brugada criteria increased the sensitivity of VT diagnosis (93.8 %) And accuracy (86.6%), but the specificity was low (77.1%). The Brugada standard combined with Steurer standard could further improve the specificity (89.6%) and accuracy (92.0%) of the diagnosis of VT. Further analysis showed that: the Brugada criteria for VT caused by organic factors, right bundle branch block (RBBB) idiopathic VT (IVT), SVT with indoors differential conduction (AC) or the original unilateral bundle branch conduction (LBBB) idiopathic VT, SVT with the original double-branch block, myocardial necrosis or myocardial infarction with a wide range (96.3% ~ 100.0%); The coincidence rate of QRS wave SVT and WPW with pre-transmission SVT (WPW-SVT) was low (0 ~ 57.1%). The combination of Steurer criteria can make WPW-SVT can be a clear diagnosis, but no significance of the first three, it is not suitable for the first three applications. CONCLUSION: The single ECG of morphologic electrocardiogram is less sensitive to VT and can not be judged by a single criterion. Brugada standard combined with Steurer standard of multiple criteria is the current method of diagnosing the sensitivity, specificity and accuracy of VT.