心电图在青少年心脏抑制型血管迷走性晕厥中的应用价值  

Application value of electrocardiogram in adolescents with cardiac inhibitory vasovagal syncope.

作　　者：赵磊[1] 吕峰峰[1] 郑晔[1] 颜利求[1] 曹绪芬[1] ZHAO Lei;LYU Feng-feng;ZHENG Ye(Department of Cardiology,Cangzhou Central Hospital,Cangzhou Hebei 061000,China.)

机构地区：[1]河北省沧州市中心医院心内一科,河北沧州061000

出　　处：《临床和实验医学杂志》2021年第10期1108-1111,共4页Journal of Clinical and Experimental Medicine

基　　金：河北省卫生和计划生育委员会科研基金项目(编号:20180890)。

摘　　要：目的研究心电图在青少年心脏抑制型血管迷走性晕厥(VVS-CI)诊断中的应用价值。方法采用回顾性分析方法,研究对象为2018年1月至2020年1月入沧州市中心医院治疗的86例VVS-CI青少年,将其作为VVS-CI组;同时,选取同期入院的86例健康青少年作为研究对象,将其设定为健康组。比较2组基础状态下12导联心电图P波时限及电压,并对其变化特点进行分析。结果与健康组相比,VVS-CI组的P波离散度(Pd)、P波最大时间(max)、P波时间(Pwd)、校正P波离散度(Pcd)、校正P波最大时间(Pcmax)更长,心率更低,差异均有统计学意义(P<0.05);2组P波电压、P波最小时间(Pmin)、校正P波最小时间(Pcmin)、校正P波时间(Pcwd)比较,差异无统计学意义(P>0.05)。受试者工作特征曲线分析显示Pcd、Pcmax、Pd、Pmax、Pwd诊断青少年VVS-CI性能较好(P<0.001),其中Pcd的AUC、95%CI、最佳截断值、灵敏度、特异度、阳性拟然比、阴性拟然比、约登指数依次为0.858、0.784~0.933、36.36 ms、83.73%、72.09%、3.00、0.23、55.81%,Pcmax的AUC、95%CI、最佳截断值、灵敏度、特异度、阳性拟然比、阴性拟然比、约登指数依次为0.676、0.561~0.792、120.89%、46.51%、88.37%、4.00、0.61、34.88%,Pd的AUC、95%CI、最佳截断值、灵敏度、特异度、阳性拟然比、阴性拟然比、约登指数依次为0.907、0.849~0.965、27.41 ms、95.35%、69.77%、3.15、0.07、65.17%,Pmax的AUC、95%CI、最佳截断值、灵敏度、特异度、阳性拟然比、阴性拟然比、约登指数依次为0.853、0.766~0.940、93.38 ms、76.74%、90.70%、8.25、0.26、67.44%,Pwd的AUC、95%CI、最佳截断值、灵敏度、特异度、阳性拟然比、阴性拟然比、约登指数依次为0.731、0.616~0.846、78.48 ms、69.77%、83.72%、4.29、0.36、53.49%。结论VVS-CI青少年的Pcd、Pcmax、Pd、Pmax、Pwd显著延长,提示心房电活动异常,心电图P波界值可用于诊断青少年VVS-CI。Objective To study the application value of electrocardiogram(ECG)in the diagnosis of cardiac inhibitory vasovagal syncope(VVS-CI)in adolescents.Methods Retrospective analysis was performed on 86 adolescents with VVS-CI who were admitted to Cangzhou Central Hospital from January 2018 to January 2020,and they were assigned to the VVS-CI group.At the same time,86 healthy adolescents who were hospitalized in the same period were selected as the research object,and they were set as the healthy group.The P-wave time limit and voltage of 12-lead ECG were compared between the two groups under the basic state,and the characteristics of their changes were analyzed.Results Compared with healthy group,P wave dispersion(PD),P wave maximum time(Max),P wave time(PWD),corrected P wave dispersion(PCD)and corrected P wave maximum time(PCmax)were longer and heart rate was lower in VVS-CI group,with significant differences(P<0.05).There was no significant difference in P-wave voltage,P-wave minimum time(PMIN),P-wave minimum time(PCMIN)and P-wave correction time(PCWD)between the two groups(P>0.05).The analysis of receiver operating characteristic curve showed that PCD,PCmax,PD,Pmax and PWD had better VVS-CI performance(P<0.001).The AUC,95%CI,optimal cutoff value,sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and Yauden index of PCD were 0.858,0.784-0.933,36.36 ms,83.73%,72.09%,3.00,0.23,55.81%,respectively.AUC,95%CI,optimal cutoff value,sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and Youden index of PCmax were 0.676,0.561-0.792,120.89%,46.51%,88.37%,4.00,0.61,34.88%,respectively.AUC,95%CI,optimal cutoff value,sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and Youden index of PD were 0.907,0.849-0.965,27.41 ms,95.35%,69.77%,3.15,0.07,65.17%,respectively.AUC,95%CI,optimal cutoff value,sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and Youden index of Pmax were 0.853,0.7666-0.940,93.38 ms,76.74%,90.70%,8.25,0.26,67.44%

关 键 词：青少年 心脏抑制 血管迷走性晕厥 心电图 

分 类 号：R741.041[医药卫生—神经病学与精神病学] R540.41[医药卫生—临床医学]