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患者男性,50岁,体检时发现心律失常。3周前有感冒史。心电图(附图)可见形态正常的窦性P,频率68次/分,P-R间期0.15秒。Ⅱ导联可见一系列提前出现的P’-QRS-T波群,P’呈逆行性,P’-P’间距0.47秒—0.50秒,其频率约为120次/分,同时可见异位P_2-P_3’间距是0.96秒,大致相当于异位起搏周期的两倍,故存在Ⅱ°传出阻滞。在R_6之前可见一介于窦性P与房性P’间较为平坦的房性融合波。粗略看来P_3’-P_4’相距2.50秒=0.50秒×5,实际上,应是2.50秒=0.50秒×(2+3)。在aVR可见3个直立的P’波,P2’-P3’间期3.28秒,非0.50秒的整倍数,说明异位灶并无传入保护。在R_3、R_7前面,各有一房性融合渡。心电图诊断:1.窦性心律,2.非阵发性房性心动过速伴Ⅱ°外出阻滞、房性融合波。讨论非阵发性房性心动过速,根据有无窦性
Male patient, 50 years old, found arrhythmia on physical examination. 3 weeks ago, a history of cold. Electrocardiogram (with photos) shows the normal form of sinus P, the frequency of 68 beats / min, P-R interval of 0.15 seconds. A series of P’-QRS-T complex appeared in Ⅱ lead, and P ’was retrograde. The interval between P’-P’ was 0.47 seconds -0.50 seconds, and the frequency was about 120 beats / min. -P_3 ’interval is 0.96 seconds, roughly equivalent to twice the ectopic pacing cycle, so there is Ⅱ ° outgoing block. Before R_6, we can see a relatively flat atrial fusion between sinus P and atrial P ’. Roughly speaking, P_3’-P_4 ’is 2.50 seconds apart = 0.50 seconds × 5, in fact, it should be 2.50 seconds = 0.50 seconds × (2 + 3). In aVR visible three upright P ’wave, P2’-P3’ interval of 3.28 seconds, non-0.50 second integer multiples, indicating ectopic foci no protection. In front of R_3, R_7, each room has a fusion crossing. ECG diagnosis: 1. Sinus rhythm, 2. Non-paroxysmal atrial tachycardia with Ⅱ ° block, atrial fusion wave. Discussion of non-paroxysmal atrial tachycardia, depending on the presence or absence of sinus