平板运动试验在筛查冠心病高危患者中的作用  

The study of high-risk stratification by exercise among patients with coronary heart disease

作　　者：翟锁玲[1] 赵磊 张治[1] 洪江[1] 刘少稳[1] Zhai suoling;Zhao lei;Zhang zhi;Hong jiang;Liu shaowen(Shanghai First People's Hospital,Shanghai,200080,China)

机构地区：[1]上海市第一人民医院,200080

出　　处：《临床心电学杂志》2021年第3期185-188,共4页Journal of Clinical Electrocardiology

摘　　要：目的在平板运动试验中,及时识别高危患者的心电图表现。方法分析我院2016年至2020年血管造影1174例,以至少一根血管闭塞面积>70%为高危组(n=494);闭塞面积<70%的患者,不需马上介入治疗为普通组(n=680),比较两组平板运动试验阶段中的心电图表现。结果高危组有明显的特征:(1)新出现的ST段水平或弓背抬高,a VR导联单独抬高>0.1mV;(2)心脏各壁ST段压低单独或合并出现压低>0.2mV,持续时间>5分钟,持续至恢复阶段至少3分钟;(3)运动中出现频发室早,短阵室性心动过速伴ST段压低;(4)新出现的各类传导阻滞伴ST段压低和a VR导联ST段抬高;(5)出现De winter图形;(6)胸痛伴ST段压低或血压下降,这些特点为高危组在运动中新发生的特有表现,两组间有明显差异。结论平板运动试验能够检出高危患者,高危患者有明显的心电图特征。Objective To identify the ECG performance of high-risk patients during the treadmill exercise test.Methods We retrospectively analyzed the result of treadmill exercise test(TET)of 1174 patients had coronary heart disease(CHD)who accepted coronary angiograph in Shanghai First Hospital from 2016 to 2020.According to the result of coronary angiography,all the patients were divided into high-risk CHD group(n=494)and common CHD group(n=680).Patients in the high-risk group had>70%blocked in at least of one vessel.We compared the types and characteristics of the patients’electrocardiogram(ECG)during the TET in the two groups.Results The high-risk groups have significantly ECG signs:(1)Newly appear ST segment level or arched elevation,ST segment elevation>0.1 mV in lead a VR;(2)ST segment depression>0.2 mV lasted over 5 minutes in the corresponding leads of each wall of the ventricle,it lasted at least 3 minutes until the recovery phase;(3)Frequent premature ventricular contractions,paroxysmal ventricular tachycardia accompany ST depression;(4)New appeared conduction block and ST segment depression,and ST segment elevation in lead a VR;(5)De winter picture;(6)Chest pain and low blood pressure and ST segment depression.Conclusions Treadmill exercise test(TET)can find high-risk CHD patients,High-risk patients have significant ECG signs.

关 键 词：平板运动试验 冠脉造影 心电图 

分 类 号：R541.7[医药卫生—心血管疾病] R540.41[医药卫生—内科学]