无创心脏监护时程的选择在检出心律失常和心肌缺血中的意义  

Significance of different cardiac noninvasive monitoring duration for detection of arrhythmia and ischemia

作　　者：王晋丽[1] 陈韵岱[1] 石亚君[1] 王佳平[1] 郜玲[1] 郭亚涛[1] 杨勇[1] 卢喜烈[1] 

机构地区：[1]中国人民解放军总医院心内科,北京100853

出　　处：《中国心血管杂志》2015年第2期119-122,共4页Chinese Journal of Cardiovascular Medicine

基　　金：国家科技部支撑计划基层心电产品应用评价研究项目(2013BAI17B06)~~

摘　　要：目的研究心电监护时间对检出心律失常和心肌缺血的价值。方法回顾性研究2013年1—12月可疑或已诊断心脏病患者2 593例。根据患者监护时间长短分为:24 h组(2 391例),48 h组(49例)和72 h组(153例)。比较三组间临床特点和动态心电监护参数差异。结果72 h组较24 h组患者年龄大[(55.7±18.7)岁比(52.3±18.4)岁,F=3.996,P=0.03]。三组患者的平均心率为(74.1±11.7)次/min,平均心率在24 h组[(74.4±11.7)次/min]和48 h组[(73.7±9.8)次/min]均较72 h组[(69.1±12.3)次/min]快(F=14.987,P<0.01)。患者就诊症状中伴头晕/晕厥症状的比例差异有统计学意义[24 h、48 h和72 h组的比例分别为5.4%(127/2 391),8.2%(4/49)和23.5%(36/153),χ2=80.1,P<0.01]。患者就诊症状中伴心慌/心悸症状的比例差异有统计学意义[24 h、48 h和72 h组的发生率分别为22.1%(528/2 391)比12.2%(6/49)比13.7%(21/153),χ2=8.424,P=0.02]。大于2.0 s的RR间期长间歇在时间长的监护中可以有效检出[5.6%(133/2 391),6.1%(3/49)比15.7%(24/153),χ2=24.456,P<0.01]。选择长时程监护在检出房性心动过速、心房颤动、心房扑动和室性心动过速的患者中较短时程监护更有优越性(χ2=29.980,17.195,12.326,10.231;均为P<0.01),而ST-T改变的检出率三组之间差异无统计学意义(χ2=4.496,1.559;均为P>0.05)。结论医生更倾向于选择72 h动态心电监护监测就诊症状中有头晕/晕厥的患者,选择24 h监测就诊症状中有心慌/心悸的患者,延长心电监护时间可能在检出心律失常中更有意义,但监护时间的长短对心肌缺血的检出影响不大。Objective Dynamic electrocardiogram （ ECG ） monitoring is a well-established noninvasive method to monitor patients with syncope, chest pain or to diagnose arrhythmias and ischemia. The most effective duration of monitoring has not been established. The objective of this study is to investigate the significance of cardiac noninvasive monitoring duration for detecting arrhythmia and ischemia. Methods A retrospective study was performed in 2 593 patients with suspected or diagnosed heart diseases from Jan. 2013 to Dec. 2013. Clinical characteristics and dynamic ECG monitoring parameters were analyzed. Patients were divided into three groups based on their monitoring durations： group 24 h （2 391 cases, aged 2 to 97 years）, group 48 h （49 cases, aged 15 to 86 years） and group 72 h （153 cases, aged 16 to 91 years）. Results There was statistical difference between group 24 h and group 72 h in age [（52. 3 ±18. 4） years vs. （55. 7 ±18. 7） years, F = 3. 996, P = 0. 03]. The average heart rate was （74. 1 ± 11. 7）＆amp;nbsp;bpm. Average heart rates were decreased with monitoring durations increased among three groups [（74. 4 ± 11. 7） bpm vs. （73. 7 ± 9. 8） bpm vs. （69. 1 ± 12. 3） bpm, F = 14. 987, P 〈 0. 01] . （1） Patients with syncope syndrome performed longer monitoring among group 24 h, group 48 h and group 72 h, incidence rate 5. 4% , 8. 2% and 23. 5% respectively, particularly in men （X2 = 80. 1, P 〈 0. 01） . （2） Patients with palpitation were likely to undergo 24-hour monitoring in three groups （22. 1% vs. 12. 2% vs. 13. 7% , X2 =8. 424, P =0. 02）. （3） Long RR intervals （ 〉2. 0 s） were detected more effectively in long-term monitoring among three groups （5. 6% vs. 6. 1% vs. 15. 7% , X2 =24. 456, P 〈0. 01）. Atrial fibrillation, atrial flutter, atrial tachycardia and ventricular tachycardia could be highly detected after long-term monitoring （ X2 =29. 980, 17. 195, 12. 326, 10. 231, P 〈0. 01）, while ST segment and T wave changes d

关 键 词：心电描记术 便携式 心律失常 心性 心肌缺血 

分 类 号：R541.7[医药卫生—心血管疾病] R542.2[医药卫生—内科学]