患者女性，8岁，先天性心脏病，行法洛四联症手术。图5-3为术后发生的心动过速：
应诊断为（）
A.预激综合征合并心房颤动
B.室性心动过速
C.室上性心动过速合并右束支阻滞
D.房性心动过速伴室内差异传导
E.心房扑动1：1传导
参考答案：B
解析：
室性心动过速解析：心电图为12导联同步记录。此例为宽QRS波心动过速。许多情况可引起宽QRS波心动过速，其中最常见的原因为室性心动过速和室上性心动过速伴室内差异性传导，两者应注意鉴别。本图心室率200次／分，QRS时限0.16秒，V1～V6导联QRS波均以正向波为主，提示室性心动过速。仔细观察同步12导联V1及aVR导联可见明确的房室分离（箭头所示为P波），且心室率快于心房率，可明确诊断为室性心动过速。V1导联QRS波呈右束支阻滞图形，Ⅱ、Ⅲ、 aVF导联QRS主波向上，提示室性心动过速起源于左室心底部，可能与手术创伤有关。
| I was wandering through the streets when I caught sight of a tailor's shop.I wanted very much to get a new suit and throw off my old 1 . But … I had nothing in the world but a million-pound note. I went in 2 asked if they had a cheap 3 .The fellow I spoke to 4 no answer at first,looked me up and down,noticed that I was almost in rags, 5 said, "just a minute." I waited till he 6 his work.Then he took me into a dark back room.He looked through the suits and 7 the cheapest one for me.I put it on.It didn't fit, 8 it was new and I was anxious to have it, so I said: "Could you wait a few days for the money?I haven't any small change on me." The fellow looked at me 9 and said, "Oh, you haven't? Well,of couse, I know that gentlement like you carry only 10 notes." I was 11 and said, "My friend,you shouldn't judge a stranger always by the clothes he wears. I'm quite 12 to pay for this suit. But I'm afraid you can't change the note." "Why do you think we can't change your note? 13 the contrary,we can!" I handed the note to him and said: "Oh,very well,I apologize." He 14 it with a smile,and then as he looked at the note,his smile froze. 15 the note in his hand,he stood there,unable to talk or move. | ||||
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