儿童青少年心脏抑制型血管迷走性晕厥心电图P波的变化及诊断价值

doi:10.7499/j.issn.1008-8830.2019.11.006

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摘要

目的探讨儿童青少年心脏抑制型血管迷走性晕厥（VVS-CI）心电图P波的变化及诊断价值。方法选择43例明确诊断的VVS-CI儿童青少年为VVS-CI组，同期选取43例健康儿童青少年为对照组。测量两组基础状态下12导联心电图P波时限和电压，并分析其变化特点。结果 VVS-CI组心率低于对照组（P < 0.05），VVS-CI组P波时间（Pwd）、P波最大时间（Pmax）、P波离散度（Pd）、校正P波最大时间（Pcmax）、校正P波离散度（Pcd）较对照组延长（P < 0.05）。Pwd、Pmax、Pd、Pcmax、Pcd对儿童青少年VVS-CI有诊断价值（P < 0.05）。Pwd最佳截断值为78.49 ms，灵敏度为69.77%，特异度为83.72%；Pmax最佳截断值为93.39 ms，灵敏度为76.74%，特异度为90.70%；Pd最佳截断值为27.42 ms，灵敏度为95.35%，特异度为69.77%；Pcmax最佳截断值为120.90 ms，灵敏度为46.51%，特异度为88.37%；Pcd最佳截断值为36.37 ms，灵敏度为83.72%，特异度为72.09%。结论儿童青少年VVS-CI的Pwd、Pmax、Pd、Pcmax、Pcd明显延长，提示可能存在心房电活动异常。P波界值对儿童青少年VVS-CI具有诊断价值。

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	王双双
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关键词 ：心脏抑制型血管迷走性晕厥, 直立倾斜试验, 心电描记术, P波, 儿童, 青少年

Abstract：Objective To study the change in P wave on electrocardiogram and its diagnostic value in children and adolescents with cardioinhibitory vasovagal syncope (VVS-CI). Methods A total of 43 children and adolescents who were diagnosed with VVS-CI were enrolled as the VVS-CI group, and 43 healthy children and adolescents were enrolled as the control group. P wave duration and P wave voltage were measured by 12-lead electrocardiography in a basal state, and the changes were analyzed. Results Compared with the control group, the VVS-CI group had a significantly lower heart rate (P < 0.05) and significantly longer P wave duration (Pwd), P wave maximum duration (Pmax), and corrected P wave maximum duration (Pcmax), as well as significantly higher P wave dispersion (Pd) and corrected P wave dispersion (Pcd) (P < 0.05). Pwd, Pmax, Pd, Pcmax and Pcd had a certain diagnostic value in children and adolescents with VVS-CI (P < 0.05):Pwd had a sensitivity of 69.77% and a specificity of 83.72% at the optimal cut-off value of 78.49 ms; Pmax had a sensitivity of 76.74% and a specificity of 90.70% at the optimal cut-off value of 93.39 ms; Pd had a sensitivity of 95.35% and a specificity of 69.77% at the optimal cut-off value of 27.42 ms; Pcmax had a sensitivity of 46.51% and a specificity of 88.37% at the optimal cut-off value of 120.90 ms; Pcd had a sensitivity of 83.72% and a specificity of 72.09% at the optimal cut-off value of 36.37 ms. Conclusions Children and adolescents with VVS-CI have significantly increased Pwd, Pmax, Pd, Pcmax, and Pcd, which may indicate abnormal atrial electrical activity. The cut-off value of P wave has a certain diagnostic value in VVS-CI.

Key words： Cardioinhibitory vasovagal syncope Head-up tilt test Electrocardiography P wave Child Adolescent

收稿日期: 2019-07-05

通讯作者: 王成,男,主任医师,教授。Email:wangcheng2nd@csu.edu.cn。 E-mail: wangcheng2nd@csu.edu.cn

作者简介: 王双双,女,硕士研究生,住院医师。

引用本文:

王双双,易秀英,纪青等. 儿童青少年心脏抑制型血管迷走性晕厥心电图P波的变化及诊断价值[J]. 中国当代儿科杂志, 2019, 21(11): 1084-1088.

WANG Shuang-Shuang,YI Xiu-Ying,JI Qing et al. Change in P wave on electrocardiogram and its diagnostic value in children and adolescents with cardioinhibitory vasovagal syncope[J]. CJCP, 2019, 21(11): 1084-1088.

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http://www.zgddek.com/CN/10.7499/j.issn.1008-8830.2019.11.006 或 http://www.zgddek.com/CN/Y2019/V21/I11/1084

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