PV1终末电势对煤工尘肺肺心病并发左心室肥大诊断的意义

摘要

目的 探讨心电图PV1终末电势(Ptf-V1)对诊断煤工尘肺肺心病并发左心室肥大的价值.方法 选择煤工尘肺尸检病例中病理诊断为肺心病并发左心室肥大并有测量Pff-V1资料者,按心电图心电轴左偏、无偏和右偏分别选择14例,进行左心室壁厚、右心室壁厚测量,并进行分析.结果 心电轴左偏组、无偏组和右偏组左、右心室壁厚均数比较,差异有统计学意义(F=32.18,P＜0.01；F=8.02,P＜0.01)；心电轴左偏组左心室壁厚[(1.81±0.18)cm]明显大于无偏组[(1.47±0.15)cm]和右偏组[(1.39±0.10)cm],差异有统计学意义(P＜0.01),心电轴左偏组右心室壁厚[(0.79±0.14)cm]明显大于无偏组[(0.58±0.14)cm],差异有统计学意义(P＜0.01),心电轴右偏组有心室壁厚[(0.71±0.14)cm]明显大于心电轴无偏组,差异有统计学意义(P＜0.05).心电轴左偏组Ptf-V1检出率(85.71％)明显高于无偏组(35.70％)及右偏组(28.57％),差异有统计学意义(P＜0.01),Ptf-V1绝对值与心电轴左偏组及无偏组左心室壁厚呈正相关(r1=0.92,P＜0.01；r2=0.93,P＜0.05).结论 Pff-V1绝对值增大可作为左心室形态和功能(尤其是左心房负荷增重改变)的判断指标,心电图Ptf-V1结合心电轴左偏对煤工尘肺肺心病患者并发左心室肥大诊断具有一定价值.%Objective To determine the value of terminal force of P wave in V1 lead(Ptf-V1)in the diagnosis of coal-workers' pneumoconiosis with pulmonary heart disease complicated by left ventricular hypertrophy.Methods Select the coal-worker with pneumoconiosis postmortem examination cases which were pathologically diagnosed as pulmonary heart disease complicated by left ventricular hypertrophy and can measure Ptf-V1.Select 14 cases with ECG left axis deviation,no deviation and right axis deviation.Measure and analyze the Pff-V1 value,the thickness of left and right ventricular wall.Results There' s obvious discrepancy in ventricular wall thickness mean in ECG left axis deviation,no deviation and right axis deviation groups,the discrepancy have statistical significance(F1=32.18,P＜0.01,F2=8.02,P＜0.01).The left ventricular wall is thicker in ECG left axis deviation group[(1.81±0.18)cm]than in no deviation[(1.47±0.15)cm]and right axis deviation groups[(1.39±0.10)cm],the discrepancy have statistical significance with(P＜0.01).The right ventricular wall is thicker in ECG left axis deviation group[(0.79±0.14)cm]than in no deviation group[(0.58±0.14)cm],the discrepancy have statistical significance with(P＜0.01).The right ventricular wall is thicker in ECG right axis deviation group[(0.71±0.14)cm]than in no deviation group,the discrepancy have statistical significance with(P＜0.05).ECG left axis deviation Ptf-V1 relevance ratio 85.71％ is higher than in no deviation(35.70％)and right axis deviation groups(28.57％),the discrepancy have statistical significance with(P＜0.01).The Pff-V1 absolute value is positively related with left ventricular wall thickness in ECG left axis deviation and no deviation groups(r1=0.92,P＜0.01,r2=0.93,P＜0.01).Conclusion Pft-V1 absolute value is the criterion index of lefi ventricular morphosis and function especially left atrium loading change.ECG Pff-V1 combined with ECG left axis deviation is valuable to the diagnosis of coalworkers with pneumoconiosis complicated by left ventricular hypertrophy.