肥厚型心肌病的超声心动图及心电图分析

收稿日期:2006212230;修回日期:200722215

作者简介:周勤(19702),女,主治医师,从事心血管内科工作。

・临床研究・

肥厚型心肌病的超声心动图及心电图分析

周　勤,朱仁贤,肖玉梅,汤品华,盛冬梅,郑云峰,杨磊清

(上海市金山区亭林医院,上海　201505)

[摘　要]　目的　观察肥厚型心肌病的心电图和超声心动图特点。方法　对临床确诊的32例肥厚型心肌病

患者心电图、超声心动图资料进行回顾性分析。结果　所有患者心电图均有异常,以ST -T 改变、左室高电压和异常Q 波为多见。Q 波深度与室间隔厚度、ST 压低深度与心尖部室壁厚度均呈正相关,而T 波深度与心尖部室壁厚度无相关性,但与心尖部和室间隔的室壁厚度差呈正相关,左房大小与平均室壁厚度呈正相关。结

论　在肥厚型心肌病中,心电图和超声心动图中的许多异常指标具有相关性,两者结合可提高本病诊断率。[关键词]　肥厚型心肌病;心电图;超声心动图中图分类号:R54212 文献标识码:A 文章编号:10092816X (2007)022*******

ECG and UCG Analysis of 32P atients with H ypertrophic C ardiomyp athy.ZH OU Qin ,ZH U Ren -xian ,XIAO Yu -mei ,et al.The Tinling Hospital ,Shanghai 201505,China [Abstract]Objective T o analyse the changes of electrocardiogram (ECG )and echocardiography (UCG )in 32patients with hypertrophic cardiomypathy.Methods 32cases with hypertrophic cardiomypathy were reviewed based on the clinical ,ECG and UCG data.R esults All cases had abnormal ECG.The m ost frequent abnormal was ST segment and T wave changes.The second was left ventricle high v oltage and the third was abnormal Q wave.The depth of Q wave had linear correlation with the thickness of interventricular septum (I VS ).And the depth of ST segment depression had linear correlation with the thickness of apical ventricular wall.But the depth of negative T wave was not related with the thickness of apical (AP )ven 2tricular wall ,and it had linear correlation with the difference in thickness of ventricular wall between AP and I VS.The left atrial size had linear correlation with the average thickness of the left ventricular wall.Conclusions Many abnormalities of ECG and UCG are in relation to each other in hypertrophic cardiomypathy.The combination of ECG and UCG is important for the diagnosis of hypertrophic cardiomypathy.

[K ey w ords]Hypertrophic cardiomypathy ;ECG;UCG

肥厚型心肌病临床症状缺乏特异性,心电图敏感性高,但特异性差,临床上易误诊为心肌缺血或心肌梗死。超声心动图虽可确诊本病,但易受患者透声条件和超声医生临床经验的影响。本文对我院1997年1月至2006年9月确诊为肥厚型心肌病的32例患者的临床资料、心电图和超声心动图特点作回顾性分析,结果如下:1　资料与方法

111　一般资料:所有病例均为我院住院或门、急诊病例,均经超声心动图确诊,1例患者因诊断不明

确去外院行冠脉造影和左室造影而确诊。本组共32例,男20例,女12例,年龄平均50172±13103岁,年龄最大76岁,最小21岁。32例中无临床症状者3人;体力活动后胸闷、气促者26人,心悸者8

人;心前区疼痛者9人;头晕、晕厥者3人;因心力

衰竭而死亡者2例,猝死1例,1例患者肥厚型心肌病同时合并室壁瘤,心功能Ⅲ级。其中5例共2家有家族史:一家为女儿和母亲;另一家为父亲和两个儿子。体征:胸骨左缘3、4肋间或心尖部闻及Ⅲ～Ⅳ/6级收缩期杂音者10例。112　方法:所有病例均行彩色多普勒超声心动图及心电图检查。使用仪器为LOGI Q -400C L ,探头频率215MHZ ,患者左侧卧位或平卧位,均为经胸超声检查,均行常规检查和测量,以及各节段室壁厚度的测量。心电图机为GE M AC1200型12道心电图仪及上海光电厂6511型心电图仪。

超声心动图诊断心肌肥厚标准:肥厚的室间隔呈纺锤状凸入左室流出道(LVOT ),呈条索状多层回升,活动幅度减弱,收缩期增厚率<30%,室间隔/左室后壁>115或心肌绝对厚度>15mm 。

LVOT 梗阻诊断标准:LVOT 宽度≤10mm ,二尖瓣前叶收缩期前移(S AM 征)或跨LVOT 压力阶差>30mmHg 者判定为LVOT 梗阻。LVOT 内可见

・67・　Prevention and Treatment of Cardio 2Cerebral 2Vascular Disease Apr 2007.　Vol 7.　No 2