远程监测对急性ST段抬高心肌梗死的应用价值  

Clinical value of remote electrocardiogram monitoring in patients with acute ST-segment elevation myocardial infarction

作　　者：孙筱璐[1] 孙妍[1] 王国干[1] 

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外心血管病医院,心血管疾病国家重点实验室,急重症中心,北京100370

出　　处：《中华急诊医学杂志》2014年第4期416-420,共5页Chinese Journal of Emergency Medicine

基　　金：北京市教育委员会科技成果转化与产业化项目（2009-BXQI）

摘　　要：目的 旨在评价远程实时心电监测系统应用于急性ST段抬高心肌梗死（STEMI）心电信号的有效性,评价心肌缺血的准确性,并探讨其在STEMI中的临床使用价值.方法 入选2008年4月至2010年12月北京阜外心血管病医院收治的60例STEMI患者.所有受试者均进行远程心电监测及常规12导联心电图机监测,并分成远程心电图组和常规心电图组进行比较.远程心电图组采集模拟V1、V3和V5导联及Ⅰ导联.分别测量两组心电图P波时限、PR间期、QRS波时限、T波时限、QT间期等指标,以及各导联P波振幅、QRS波振幅、QRS综合压代数和压差即R-（Q＋S）,T波振幅等指标,比较两组心电图对心律失常的检出率,两组在V1、V3和V5导联及Ⅰ导联中心电波形的一致性和各导联ST段改变的敏感性.数据分析采用成组t检验、秩和检验、Pearson相关分析法、Spearman秩相关和x2检验.结果 经检验STEMI患者,两组图形在心率、P波时限、PR间期、QRS波时限、T波时限、QT间期等参数均差异无统计学意义（P＞0.05）,参数相关良好（P＜0.01）.两组合并心律失常检出率差异无统计学意义（P＞0.05）.除V1导联远程心电图ST段抬高诊断符合率低于常规12导联心电图外（P＜0.05）,V3、V5和Ⅰ导联ST段抬高诊断符合率与12导联心电图相符（P＞0.05）.结论 远程心电监测有助于STEMI患者心肌缺血部位的判定,且能够检测出心肌梗死后的心律失常,因此肯定了远程心电监测系统对STEMI的应用价值.Objective To investigate the reliability of electrocardiographic （ECG） signal for the accurate assessment of myocardial ischemia in order to evaluate the clinical value of remote real-time ECG monitoring system based on GPRS in patients with acute ST-elevation myocardial infarction （STEMI）.Methods A total of 60 STEMI patients admitted between April 2008 and December 2010 were enrolled.All subjects were given the remote real-time ECG monitoring and routine 12 leads ECG monitoring at the same time.They were divided into remote ECG group and the 12 leads ECG group.The remote real-time ECG monitoring collects electrocardiosignal to imitate V1,V3,V5 lead and Ⅰ lead.P wave duration,PR interval,duration of time limit of QRS wave and T wave,QT interval,and the P wave amplitude,QRS wave amplitude,R-（Q ＋ S）,T wave amplitude were measured,and the detectability rate of arrhythmia and the definited diagnosis rate of ST segment elevation in accordance with clinical manifestion were compared in each group with different parameters.The data were analyzed by t test,rank sum test,Pearson correlation analysis,Spearman＆#39;s rank correlation and the chi-square test.Results In STEMI patients,there were no statistical differences in time limits and amplitude of waves on ECG between the two groups （P 〉 0.05）,and the correlations between parameters of two groups were found to be close （P 〈 0.01）.There was no difference in the detectability rate of cardiac arrhythmia between two groups （P 〉 0.05）,and no difference in the rate of correct diagnosis of elevated ST segment between two groups （P 〉 0.05）,except V1 lead （P 〈 0.05）.Conclusions The sensitivity of the change in ST segment of the two groups is similar,and the remote real-time ECG monitoring can help determine the location of myocardial ischemia.

关 键 词：远程监护 远程心电图 心电手机 急性ST段抬高心肌梗死 

分 类 号：R542.22[医药卫生—心血管疾病]