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患者男性,18岁,学生,临床诊断急性病毒性心肌炎,于1980年4月8日入院,经治疗于5月16日痊愈出院。附图是患者入院次日所测的a VF和V_5导联心电图。P波形态正常,P-P周期变化于0.64—0.94秒之间,各P-P之差大于0.12秒,平均心房率约79次/分,为窦性心律不齐。QRS波群形态和时限正常,仅V_5电压高达4.2mV,大部分R-R节律匀齐(V_5的R_(4-5)除外),其周期为0.96—0.98秒,约合心室率62次/分。P与QRS之间无传导关系,处于阻滞性分离状态。因此,本图的主要诊断是Ⅲ°房室传导阻滞。V_5的R_4-R_5突然延长达1.65秒,R_5-R_6仍然为心室的基本周期0.96秒。长R_4-R_5短于两个心室周期之和(1.65<0.96—0.98×2)。据此,可推测P_5的冲动已下传至交界区,使之节律重排。又由于P_5的冲动未能继续下传心室,只传至交界区的一定深度(即交界区隐匿性夺获),所以造成R_4-R_5这个长间歇。V_5导联的P_5之所以能下传而夺获交界区,可能是因为交界区此时处在超常期。交界区逸搏冲动下传心室的同
Patient Male, 18 years old, student, clinical diagnosis of acute viral myocarditis, admitted to hospital on April 8, 1980 and was discharged on May 16 after treatment. The figure is a VF and V_5 lead electrocardiogram measured on the next day after admission. P wave morphology is normal, P-P cycle changes between 0.64-0.94 seconds, the difference between the P-P greater than 0.12 seconds, the average atrial rate of about 79 beats / min, sinus arrhythmia. QRS wave group morphology and duration of normal, only V_5 voltage up to 4.2mV, most of R-R rhythm (V_5 R_ (4-5) except), the cycle 0.96-0.98 seconds, about the ventricular rate 62 beats / min. There is no conduction between P and QRS, in a state of retardation. Therefore, the main diagnosis of this figure is Ⅲ ° atrioventricular block. V_5 R_4-R_5 suddenly extended for 1.65 seconds, R_5-R_6 still ventricular basic cycle 0.96 seconds. Long R_4-R_5 is shorter than the sum of two ventricular cycles (1.65 <0.96-0.98 × 2). Accordingly, it can be speculated that the impulse of P_5 has been transmitted to the junction area, so rhythm rearrangement. And because of the impulse P_5 failed to continue to download the ventricle, only spread to the junction of a certain depth (that is, the occult occult area captured), resulting in R_4-R_5 this intermittent. The reason why P_5 of V_5 can be downloaded to capture the junction area may be because the junction area is in an abnormal state at this time. Junction zone escape impulse down the same ventricle