【摘要】 目的 分析宽QRS心动过速（WCT）各导联的起始激动速度（Vi）、终末激动速度（Vt）及Vi/Vt值，探讨其在WCT鉴别诊断中的应用价值。方法 回顾性分析2011年11月至2020年6月在浙江大学医学院附属邵逸夫医院经12导联常规心电图诊断为WCT的患者100例[其中室性心动过速（VT）70例，室上性心动过速（SVT）30例]。测量WCT各导联Vi和Vt，计算Vi/Vt，绘制ROC曲线，比较其鉴别诊断WCT的效能。结果 就Vi而言，在I、avR及胸V₁-V₆导联SVT均快于VT（P<0.05）；肢体导联及胸V₄-V₆导联，SVT的Vt均慢于VT（P<0.05）；各导联（除了V₁导联）SVT的Vi/Vt值均大于VT（P<0.05）。通过ROC曲线分析，avR及V₅导联有最大且相似的曲线下面积（AUC），分别为0.85（0.76～0.91）和0.86（0.77～0.92），最佳临界值均为1.75。结合导联QRS时限，QRS时限介于120～159 ms时，avR及V₅导联的AUC最高，当avR及V₅导联QRS时限<120 ms时，最佳临界值明显提高。结论 avR导联及V₅导联Vi/Vt比值较其余导联在WCT鉴别诊断中更有价值，但其最佳临界值可能并不是1，同时对于不同导联不同QRS时限，设置合适的Vi/Vt临界值可能有助于提升WCT鉴别诊断的效能。更多还原

【Abstract】 Objective The purpose of this study was to explore the value of the initial （Vi） and teiminal （Vt） ventricular activation velocity and ratio of them （Vi/Vt） of every electrocardiographic（ECG）leads in the differential diagnosis of Wide QRS-complex Tachycardia（WCT）. Methods 100 WCTs[including 70 cases of ventricular tachycardia （VT） and 30cases of supraventricular tachycardia（SVT）] from 100 patients with proven diagnoses at the Run Run Shaw Hospital from November 2011 to June 2020 were analyzed. Vi and Vt of every ECG leads of the WCTs were measured,Vi/Vt were calculated,and ROC curves were drawn to compare the efficacy of these indicators in differential diagnosis of WCT. Results In terms of Vi,SVTs were faster than VTs in I,avR and V₁-V₆ leads（P < 0.05）. Vt of SVTs were slower than that of VTs in limb and V₄-V₆ leads（P < 0.01）. The Vi/Vt value of SVTs in most ECG leads,except lead V₁,were higher than that of VTs（P < 0.05）. According to ROC curve analysis,lead avR and V₅ had the largest and similar area under the curve（AUC）of 0.85（0.76-0.91） and 0.86（0.77-0.92）,respectively,and the optimal critical value was 1.75 for both. Combined with QRS duration,the AUC were the highest when the QRS duration of the avR and V₅ leads were between 120-159 ms,and the optimal cutoff value of them may not be 1,and for different QRS and different ECG leads,setting a suitable Vi/Vt critecal value may help to improve the performance of WCT differential diagnosis.更多还原