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病例分享：房颤伴预激？多形性室速？房颤并发差异性传导？

2018-02-12 江苏省人民医院 卢妙 许迪 黄元铸 中国医学论坛报今日循环

房颤预激综合征多形性室速
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1例53岁女性患者，心悸伴头晕半小时，心电图如下。

1例53岁女性患者，心悸伴头晕半小时，心电图如下。



心电图诊断

1. 房颤伴预激综合征（WPW）；2. 心率152次/分。

提示

1. 该患者的心电图呈不规则心室律（平均心率152次/分），QRS波宽度多变，但同一导联中，心室波主波向量基本一致，少数QRS波起始部位有可疑δ波，未见明显P波。根据该心电图，考虑本例患者为房颤伴WPW。

2. 节律不规则的宽ORS波往往需考虑以下几种情况：①房颤伴传导异常（束支传导阻滞或室内差异性传导）；②房颤伴WPW；③多形性室速，特别是扭转型室速。因此，临床应格外注意房颤伴旁道前传等宽度QRS波心动过速的鉴别诊断（表）。

表：房颤伴旁道前传等宽度QRS波心动过速的鉴别诊断


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  1. [GetPortalCommentsPageByObjectIdResponse(id=1757943, encodeId=3e911e5794383, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Sun Jul 22 09:25:00 CST 2018, time=2018-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2029053, encodeId=ded0202905313, content=<a href='/topic/show?id=27134324425' target=_blank style='color:#2F92EE;'>#多形性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43244, encryptionId=27134324425, topicName=多形性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Tue Mar 27 14:25:00 CST 2018, time=2018-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=288627, encodeId=48fd28862e77, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Sat Feb 17 09:03:36 CST 2018, time=2018-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1479748, encodeId=064114e9748ae, content=<a href='/topic/show?id=a9ab4624280' target=_blank style='color:#2F92EE;'>#室速#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46242, encryptionId=a9ab4624280, topicName=室速)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5bbc7579990, createdName=124987e8m09暂无昵称, createdTime=Wed Feb 14 06:25:00 CST 2018, time=2018-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287388, encodeId=24fb28e3885f, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Mon Feb 12 16:41:37 CST 2018, time=2018-02-12, status=1, ipAttribution=)]
    2018-07-22 丁鹏鹏

    #并发#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1757943, encodeId=3e911e5794383, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Sun Jul 22 09:25:00 CST 2018, time=2018-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2029053, encodeId=ded0202905313, content=<a href='/topic/show?id=27134324425' target=_blank style='color:#2F92EE;'>#多形性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43244, encryptionId=27134324425, topicName=多形性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Tue Mar 27 14:25:00 CST 2018, time=2018-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=288627, encodeId=48fd28862e77, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Sat Feb 17 09:03:36 CST 2018, time=2018-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1479748, encodeId=064114e9748ae, content=<a href='/topic/show?id=a9ab4624280' target=_blank style='color:#2F92EE;'>#室速#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46242, encryptionId=a9ab4624280, topicName=室速)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5bbc7579990, createdName=124987e8m09暂无昵称, createdTime=Wed Feb 14 06:25:00 CST 2018, time=2018-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287388, encodeId=24fb28e3885f, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Mon Feb 12 16:41:37 CST 2018, time=2018-02-12, status=1, ipAttribution=)]
    2018-03-27 12498568m50暂无昵称

    #多形性#

    0

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    2018-02-17 changjiu

    学习一下谢谢

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1757943, encodeId=3e911e5794383, content=<a href='/topic/show?id=84ba49031f9' target=_blank style='color:#2F92EE;'>#并发#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=49031, encryptionId=84ba49031f9, topicName=并发)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a27e37327108, createdName=丁鹏鹏, createdTime=Sun Jul 22 09:25:00 CST 2018, time=2018-07-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2029053, encodeId=ded0202905313, content=<a href='/topic/show?id=27134324425' target=_blank style='color:#2F92EE;'>#多形性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43244, encryptionId=27134324425, topicName=多形性)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e452500029, createdName=12498568m50暂无昵称, createdTime=Tue Mar 27 14:25:00 CST 2018, time=2018-03-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=288627, encodeId=48fd28862e77, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Sat Feb 17 09:03:36 CST 2018, time=2018-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1479748, encodeId=064114e9748ae, content=<a href='/topic/show?id=a9ab4624280' target=_blank style='color:#2F92EE;'>#室速#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46242, encryptionId=a9ab4624280, topicName=室速)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=5bbc7579990, createdName=124987e8m09暂无昵称, createdTime=Wed Feb 14 06:25:00 CST 2018, time=2018-02-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=287388, encodeId=24fb28e3885f, content=学习一下谢谢, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zSn0GqHrsfLGSUSR8zwnWWLT4FMl5XH8S58HuZslVkLsAPbXDXaliagK7TOxQfmngKibG1yrDonepCLDkcxGk8hS/0, createdBy=b8282062892, createdName=changjiu, createdTime=Mon Feb 12 16:41:37 CST 2018, time=2018-02-12, status=1, ipAttribution=)]
    2018-02-14 124987e8m09暂无昵称

    #室速#

    0

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    2018-02-12 changjiu

    学习一下谢谢

    0

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