心电图评价颅脑损伤患者心功能障碍的价值  

Association between electrocardiographic findings and cardiac dysfunction in adult isolated traumatic brain injury

作　　者：刘秀梅[1] 王助衡[1] 孙立平[1] 李玉伟[1] 

机构地区：[1]首都医科大学大兴医院,102600

出　　处：《临床心电学杂志》2014年第6期424-427,共4页Journal of Clinical Electrocardiology

摘　　要：目的本研究的目的在于探索成年单纯颅脑损伤患者心电图改变的特征以及这些特征与发生心功能障碍之间的关系。方法回顾2013年至2014年首都医科大学大兴教学医院单纯颅脑损伤的成年患者59例。纳入入院后24h内接受12导联心电图检查并且在72h内接受超声心动图检查的单纯颅脑损伤的成年患者。排除先天性心脏病的患者。收集患者的一般临床资料、12导联心电图检查及超声心动图检查的结果。采用逻辑回归的方法检验心电图改变的特征与心功能障碍之间的相关性。结果心电图检查显示,13例（22%）出现心动过速（心率〉100bpm）,25例（42.4%）出现QT间期延长,6例（10.2%）出现复极末期异常表现。逻辑回归方法检验结果显示这3种心电图改变的特征与超声心动图提示的心功能障碍之间的比值比和95%可信区间分别是4.14（1.02～17.05）,9.0（1.74～46.65）和5.63（1.96～32.94）。心电图中心肌缺血样改变与心功能障碍之间无相关性。结论 QT间期延长和复极末期异常表现与成年单纯颅脑损伤发生后的心功能障碍存在相关性。因此,方便且无创的12导联ECG检查可以用来筛查需要进一步进行超声心动图检查的患者。Objective To examine abnormal ECG findings after isolated TBI and their association with true cardiac dysfunction, based on echocardiogram. Methods Data from adult patients with isolated TBI in Daxing Teaching Hospital of Capital Medical University between 2013 and 2014 was retrospectively examined. Inclusion criteria included the presence of a 12-lead ECG within 24 h of admission and a formal echocardiographic examination within 72 h of admission after TBI. Patients with preexisting cardiac disease were excluded. Baseline clinical characteristics, 12-lead ECG, and echocardiogram report were abstracted. Logistic regression was used to identify the relationship of specific ECG abnormalities with cardiac dysfunction. Results We examined data from 59 patients with isolated TBI who underwent 12-lead ECG and echocardiographic evaluation. In this cohort, 13（22%） patients had tachycardia（heart rate〉 100 bpm）, 25（42.4%） patients had a prolonged QTc, and 6（10.2%） patients had morphologic end-repolarization abnormalities（MERA）, with each having an association with abnormal echocardiographic findings：Odds ratios（and 95% confidence intervals） were 4.14（1.02～17.05）, 9.0（1.74～46.65）, and 5.63（1.96～32.94）,respectively. Ischemic-like ECG changes were not associated with echocardiographic abnormalities. Conclusions Repolarization abnormalities（prolonged QTc and MERA）, but not ischemic-like ECG changes, are associated with cardiac dysfunction after isolated TBI. 12-lead ECG may be an inexpensive screening tool to evaluate isolated TBI patients for cardiac dysfunction prior to more expensive or invasive studies.

关 键 词：心功能 心电图 颅脑损伤 

分 类 号：R651.15[医药卫生—外科学] R540.41[医药卫生—临床医学]