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目的 探讨扩张型心肌病伴阵发性心房颤动患者P波最大时限(Pmax)及离散度(Pd)与发生阵发性心房颤动的相关性。方法 30例扩张型心肌病伴阵发性心房颤动者为A组,扩张型心肌病无阵发性心房颤动者26例为B组。采用12导联体表心电图测定Pmax与最小时限(Pmin),计算Pd(Pd=Pmax-Pmin),并进行比较。结果 A组Pd为( 48. 4±13. 8 )ms,Pmax为(122. 8±13. 7)ms,Pmin为( 76. 2±12. 6 )ms,与B组Pd(30. 6±10. 2)ms、Pmax(110. 2±10. 4)ms、Pmin(80. 8±11. 5)ms相比明显延长(P<0. 01)。A组左心房内径(41. 4±5. 6)mm,B组(40. 2±6. 2 )mm,两组相比无显著性差异(P>0. 05 )。预测心房颤动,取P波时限≥120ms,Pd≥40ms以及两者相结合,灵敏度分别为86%、90%、73%;特异度分别为80%、85%、89%;阳性预测值分别为84%、87%、88%。结论 Pd增加和P波宽度延长,可预测扩张型心肌病并发阵发性心房颤动的危险性。
Objective To investigate the relationship between Pmax and Pd and paroxysmal atrial fibrillation in patients with dilated cardiomyopathy and paroxysmal atrial fibrillation. Methods Thirty patients with dilated cardiomyopathy accompanied by paroxysmal atrial fibrillation were group A, and 26 patients with dilated cardiomyopathy without paroxysmal atrial fibrillation were selected as group B. Pmax and minimum time (Pmin) were determined by 12-lead surface electrocardiogram and Pd (Pd = Pmax-Pmin) was calculated and compared. Results Pd in group A was (48.4 ± 13.8) ms, Pmax was (122.8 ± 13.7) ms, Pmin was (76.2 ± 12.6) ms, ± 10. 2) ms, Pmax (110.2 ± 10.4) ms, Pmin (80.8 ± 11.5) ms significantly prolonged (P <0.01). A group of left atrial diameter (41.4 ± 5. 6) mm, B group (40.2 ± 6.2) mm, no significant difference between the two groups (P> 0.05). The predictive value of atrial fibrillation was P-wave ≥120 ms, Pd ≥40 ms and their combined sensitivity of 86%, 90%, 73%, specificity of 80%, 85%, 89%, respectively 84%, 87%, 88%. Conclusions The increase of Pd and the prolongation of P wave width can predict the risk of paroxysmal atrial fibrillation in patients with dilated cardiomyopathy.