【摘要】 目的研究不同年龄组继发孔型房间隔缺损患者心电图下壁导联钩型R波发生几率,并探讨继发孔型房间隔缺损患者心电图下壁导联钩型R波的发生机制。方法观察116例单发继发孔型房间隔缺损患者按照年龄分为儿童组63例和成人组53例。计算儿童组、成人组、卵圆孔未闭组及正常对照组心电图下壁导联钩型R波及不完全型右束支传导阻滞的发生率。结果儿童组继发孔型房间隔27.0%患者1个下壁导联出现钩型R波,22.2%患者2个下壁导联出现钩型R波,14.3%患者3个下壁导联均存在钩型R波,63.5%患者至少1个下壁导联出现钩型R波;成人组继发孔型房间隔22.6%患者1个下壁导联出现钩型R波,20.8%患者2个下壁导联出现钩型R波,17.0%患者3个下壁导联均存在钩型R波,60.4%患者至少1个下壁导联出现钩型R波;2组间差异无统计学意义(P>0.05)。儿童组继发孔型房间隔55.6%患者存在不完全型右束支传导阻滞,成人组继发孔型房间隔58.5%患者不存在完全型右束支传导阻滞,2组差异无统计学意义(P>0.05)。但不同年龄组继发孔型房间隔缺损患者心电图下壁导联钩型R波和不完全型右束支传导阻滞发生率均高于正常对照组(P<0.01)。进行多元回归分析,右心室前后径/左心室前后径、房间隔缺损大小与继发孔型房间隔缺损患者心电图下壁导联钩型R波发生有相关(r=0.38、0.23,P<0.05或<0.01)。结论心电图下壁导联钩型R波和不完全型右束支传导阻滞在不同年龄组继发孔型房间隔缺损患者中发生率差异无统计学意义,但明显高于正常对照者,右心室前后径/左心室前后径、房间隔缺损大小可能与继发孔型房间隔缺损患者心电图下壁导联钩型R波发生有关。更多还原

【Abstract】 Objective To determine the clinical significance of a "crochetage" pattern-a notch near the apex of the R wave in electrocardiographic(ECG) inferior limb leads in the patients with secundum atrial septal defect of different ages.Methods The crochetage pattern and incomplete right bundle branch block were searched in 116 single secundum atrial septal defect patients,including 63 children patients and 53 adult patients.The incidence of the inferior leads hook R wave and incomplete right bundle branch block in ECG were calculated in children group,adult group,patent foramen ovale group(n =30) and normal control group(n =50).Results 21.0%of secundum atrial septal in children patients presented a hook R wave in the inferior leads,22.2%of patients two hook R waves in the inferior leads,while 14.3%of patients showed hook R waves in all three inferior limb leads.63.5%of patients manifested hook R wave at least in one inferior lead.22.6%of secundum atrial septal in adult patients presented a hook R wave in the inferior leads,20.8%of patients two hook R waves in the inferior leads,while 17.0%of patients showed hook R waves in all three inferior limb leads.60.4%of patients manifested hook R wave at least in one inferior lead.There were no statistic significance between two groups(P > 0.05 ).The incomplete right bundle branch block was found in 55.6%children patients,while that was in 58.5%adult patients,there was no significant difference between two groups (P>0.05).However,the inferior leads ECG hook R wave and incomplete right bundle branch block in different age groups of patients with secundum atrial septal defect were higher than those of normal control group(P < 0.01 ).By multiple regression analysis,only defect size(r = 0.38,P < 0.01 ) and right ventricle diameter /left ventricle diameter(r =0.23,P<0.05) were the determinants of its presence. Conclusion Inferior leads ECG hook R wave and incomplete right bundle branch block showed no significant difference among different age groups with secundum atrial septal defect,but they were significantly higher than those of normal controls,the right ventricle anteroposterior diameter / anteroposterior diameter of the left ventricle,atrial septal defect size may be associated with secundum atrial septal defect in patients with inferior wall leads ECG hook R wave.更多还原