合并完全性左束支阻滞的急性心肌梗死心电图诊断的研究  

Electrocardiogram diagnosis of acute myocardial infarction with complete left bundle branch block

作　　者：仲涛[1,2] 付基伟 韩汶君 陈岩 方燕飞 郭继鸿 ZHONG Tao;FU Jiwei;HAN Wenjun;CHEN Yan;FANG Yanfei;GUO Jihong(Department of Electrocardiography,Weifang People's Hospital,Weifang,Shandong,261041,China;Department of Cardiology,People's Hospital,Peking University)

机构地区：[1]山东省潍坊市人民医院心电图室,山东潍坊261041 [2]北京大学人民医院心内科

出　　处：《临床心血管病杂志》2021年第9期835-839,共5页Journal of Clinical Cardiology

摘　　要：目的:探讨心电图3种不同标准对合并完全性左束支阻滞(CLBBB)的急性心肌梗死(AMI)的诊断效能。方法:回顾性分析142例CLBBB患者的心电图,其中59例确诊为AMI者为心梗组,83例无AMI者为对照组。分别用巴塞罗那标准、Sgarbossa标准及Smith修定标准判读心电图,观察各标准诊断AMI的敏感度(SEN)、特异度(SPE)、阳性预测值(PPV)、阴性预测值(NPV)、准确度(CP)并作对比分析。结果:巴塞罗那标准诊断SEN为94.91%(95%CI 89.94%~98.68%),SPE为87.95%(95%CI 78.51%~93.75%),其诊断SEN、CP 90.8%(95%CI 86.0%~95.6%)、NPV 96.05%(95%CI 88.12%~98.98%)显著高于Sgarbossa标准(P=0.000)和Smith修定标准(P=0.000)。巴塞罗那标准的受试者工作特征曲线下面积0.935,高于其他诊断标准(P<0.01)。结论:巴塞罗那标准诊断合并CLBBB的AMI具有较高的诊断效能,且简单易记,方便实行,临床应用价值大。Objective:To investigate the diagnostic efficacy of three different ECG criteria in the diagnosis of acute myocardial infarction(AMI)with complete left bundle branch block(CLBBB).Methods:The electrocardiogram(ECG)of 142patients with CLBBB was retrospectively analyzed.Among them 59patients diagnosed with acute myocardial infarction were assigned to the myocardial infarction group and 83patients without acute myocardial infarction were assigned to the control group.The sensitivity(SEN),specificity(SPE),positive predictive value(PPV),negative predictive value(NPV)and capability of precision(CP)of each standard in the diagnosis of acute myocardial infarction were observed and compared among BARCRLONA algorithm,Sgarbossa criteria and Smith modified criteria.Results:The diagnostic sensitivity and specificity of the BARCRLONA algorithm were 94.91%(95%CI 89.94%-98.68%)and 87.95%(95%CI 78.51%-93.75%).The diagnostic sensitivity and capability of precision were 90.8%(95%CI 86.0%-95.6%),negative predictive value96.05%(95%CI 88.12%-98.98%)of the BARCRLONA algorithm was significantly higher than the Sgarbossa criteria(P=0.000)and the Smith modified criteria(P=0.000).The area under receiver operating characteristic curve of Barcelona algorithm was 0.935,which was higher than other diagnostic criteria(P<0.01).Conclusion:BARCRLONA algorithm has high diagnostic efficacy in the diagnosis of AMI complicated with CLBBB,and is simple to remember,convenient to implement,and has great clinical value.

关 键 词：完全性左束支阻滞 急性心肌梗死 ST段 心电图 

分 类 号：R541.7[医药卫生—心血管疾病]