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心电图学习笔记(27)少女之吻征

  • 2026-04-11 15:52:13
心电图学习笔记(27)少女之吻征
上次分享了Bix法则，今天来分享少女之吻征，其实与Bix法则类似，也是室上性心动过速发作伴房室2:1传导时所出现的现象。
定义：
‘‘少女之吻”（The Kiss of the girl)是指房室结折返性心动过速发生，并伴2：1下传激动心室时，此时的心室率不算太快，使心动过速的诊断易被漏诊(图lA)。这时的心电图上一个逆向P波落在T波上可形成T波切迹，其构成的心电图形态酷似嘴唇的外形，有人称之为“少女之吻”。看到该征应该马上想到在QRS波中可能还融有另一同样的逆向房波。据此，可最终做出房室结折返性心动过速伴2：1下传的诊断(图1B，C)。
图1，来源于朱晓晓心电资讯微信公众号。
从少女之吻的定义及图解可以得出，与Bix法则比较，其相似点：①均发生在室上性心动过速房室2:1传导时；②P'波位于两个QRS波群中间，另一个P'隐藏于QRS波群中。
不同点：少女之吻征是针对房室结折返性心动过速（AVNRT）的特有现象。也就是说，一旦出现这个少女之吻征，我们就可以下AVNRT的诊断。
我们来看病例，为动态心电图片段图。
图2，该图可见3种不同的RR间期。其中红色箭头所指为窦性P波，为窦性心律基础的RR间期；绿色箭头为房性早搏，诱发了室上性心动过速。而黄色箭头所指为埋藏于两个QRS波群中间的心房波。粉色QRS波群的T波比浅蓝色QRS波群的T波明显高尖，为心房波落在T波上导致。
图3，图1局部放大图。同样红色箭头代表窦性P，绿色代表房性早搏的P。房性早搏诱发了室上性心动过速，黄色箭头为埋于两QRS波群中间的心房波，表现为T波上的切迹，形态像不像少女之吻？
可惜动态心电图为模拟三导联，而不是正常的12导联心电图。所以也许看不出来是少女之吻征，但是房室2:1传导还是可以看出来的。
图4，红色箭头方向为AVNRT伴房室2:1传导，绿色箭头方向为AVNRT伴房室1:1传导。
图5，红色箭头所指为室上速（1:1传导）结束，绿色箭头开始恢复窦性心律。
图6，把图4局部放大，圈起来的T波上的切迹（由于心房波落在T波上导致），还是很像少女之吻的。有点模糊，凑合看。
有没有想过，当室上速出现少女之吻时，为什么说它就一定是AVNRT，而不是顺向型的AVRT（房室折返性心动过速）？因为AVNRT折返环不依靠心房和心室，当出现心房或心室阻滞时，心动过速仍可继续。而AVRT的折返环包括心房和心室，当心房或心室出现阻滞时，折返环断裂，心动过速停止，所以AVRT是不会出现房室传导阻滞的。
小总结：
少女之吻征：①心电图表现为逆向心房波藏于T波上，使T波形成切迹，形似嘴唇外形👄。②为房室结折返性心动过速（AVNRT）的特有表现，心电图出现该征提示该患者存在房室结双径路，当然，最终证实要依靠心内电生理检查。
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  1. CONNECT:[ UseTime:0.000842s ] mysql:host=127.0.0.1;port=3306;dbname=no_67808;charset=utf8mb4
  2. SHOW FULL COLUMNS FROM `fenlei` [ RunTime:0.001462s ]
  3. SELECT * FROM `fenlei` WHERE `fid` = 0 [ RunTime:0.000710s ]
  4. SELECT * FROM `fenlei` WHERE `fid` = 63 [ RunTime:0.000743s ]
  5. SHOW FULL COLUMNS FROM `set` [ RunTime:0.001568s ]
  6. SELECT * FROM `set` [ RunTime:0.015270s ]
  7. SHOW FULL COLUMNS FROM `article` [ RunTime:0.001561s ]
  8. SELECT * FROM `article` WHERE `id` = 480124 LIMIT 1 [ RunTime:0.001024s ]
  9. UPDATE `article` SET `lasttime` = 1775895313 WHERE `id` = 480124 [ RunTime:0.002746s ]
  10. SELECT * FROM `fenlei` WHERE `id` = 65 LIMIT 1 [ RunTime:0.001202s ]
  11. SELECT * FROM `article` WHERE `id` < 480124 ORDER BY `id` DESC LIMIT 1 [ RunTime:0.001221s ]
  12. SELECT * FROM `article` WHERE `id` > 480124 ORDER BY `id` ASC LIMIT 1 [ RunTime:0.003025s ]
  13. SELECT * FROM `article` WHERE `id` < 480124 ORDER BY `id` DESC LIMIT 10 [ RunTime:0.001759s ]
  14. SELECT * FROM `article` WHERE `id` < 480124 ORDER BY `id` DESC LIMIT 10,10 [ RunTime:0.002171s ]
  15. SELECT * FROM `article` WHERE `id` < 480124 ORDER BY `id` DESC LIMIT 20,10 [ RunTime:0.002454s ]
0.217376s