2019冠状病毒疾病危重症与重症患者合并心律失常的心电图分析  

Electrocardiogram analysis of arrhythmias in critically ill and severe COVID-19 patients

作　　者：王婧祎 陈旭凤[1] 王博[2] 陈静[1] 王毅娜 陈烈 贺行巍 杨晓云[1] WANG Jing-yi;CHEN Xu-feng;WANG Bo;CHEN Jing;WANG Yi-na;CHEN Lie;HE Xing-wei;YANG Xiao-yun(Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Hubei Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院心血管内科心功能检测中心,湖北武汉430030 [2]华中科技大学同济医学院附属同济医院内科,湖北武汉430030 [3]华中科技大学同济医学院附属同济医院心血管内科,湖北武汉430030

出　　处：《内科急危重症杂志》2021年第5期377-381,共5页Journal of Critical Care In Internal Medicine

基　　金：湖北省科技计划项目(No:2017ACB644)。

摘　　要：目的:分析2019冠状病毒疾病(COVID-19)危重症和重症患者心律失常的发生情况。方法:回顾性分析COVID-19危重症(117例)和重症(311例)患者的临床资料,比较2组患者心律失常发生情况、血浆氨基末端B型脑钠肽(NT-proBNP)、心肌肌钙蛋白I(cTnI)、血氧饱和度(SpO_(2))、D-二聚体及超敏C反应蛋白(hs-CRP)水平等。采用单因素和多因素logistic回归分析,研究COVID-19患者发生心律失常的相关因素。结果:COVID-19患者心律失常发生率43.9%,最常见的心律失常依次为:窦性心动过速、右束支阻滞、心房扑动或心房颤动、窦性心动过缓及房性早搏;危重症组与重症组患者中窦性心动过速、心房扑动或心房颤动、房性早搏的发生率比较,差异有统计学意义(P<0.05或P<0.01)。单因素logistic回归分析显示:高血压、SpO_(2)≤93%、cTnI、NT-proBNP、D-二聚体及hs-CRP水平升高、危重症与COVID-19患者发生窦性心动过速相关(P均<0.05)。年龄、脑卒中、SpO_(2)≤93%、cTnI、NT-proBNP、D-二聚体水平升高、危重症与COVID-19患者发生心房扑动或心房颤动相关(P均<0.05)。多因素logistic回归分析显示:高血压、cTnI水平升高、危重症是COVID-19患者发生窦性心动过速的独立相关因素(P均<0.05);年龄、NT-proBNP水平升高是COVID-19患者发生心房扑动或心房颤动的独立相关因素(P均<0.05)。结论:COVID-19患者易发生心律失常,常见心律失常为窦性心动过速、心房扑动或心房颤动。心肌损伤、高血压病史及危重症是引起COVID-19患者发生窦性心动过速的主要原因;年龄及NT-proBNP水平升高是COVID-19患者发生心房扑动或心房颤动的主要原因。Objective:To analyze the electrocardiogram(ECG)of arrhythmia in critically ill and severe COVID-19 patients.Methods:A retrospective analysis was done on the diagnosis of COVID-19.In critical cases(117 cases)and severe cases(311 cases),the basic data and the occurrence of ECG arrhythmias were compared between the two groups.N-terminal pro-B-type natriuretic peptide(NT-proBNP),cardiac troponin-I(cTnI),blood oxygen saturation(SpO_(2)),D-Dimer,and hypersensitive C-reactive protein(hs-CRP)were determined.Both univariate and multivariate logistic regression analyses were used to study the factors associated with arrhythmia in COVID-19 patients.Results:The incidence of arrhythmia in COVID-19 patients reached 43.9%,and the most arrhythmias were:sinus tachycardia,right bundle branch block,atrial flutter or atrial fibrillation,sinus bradycardia and atrial premature beats.The incidence of sinus tachycardia,atrial flutter or atrial fibrillation and atrial premature beats in the critically ill group and the severe group was statistically significant(P<0.05 or P<0.01).Univariate logistic regression analysis showed that hypertension,SpO_(2)≤93%,elevated cTnI,NT-proBNP,D-Dimer and hs-CRP,critical illness were closely related to COVID-19 patients with sinus tachycardia(P all<0.05).Age,stroke,SpO_(2)≤93%,elevated cTnI,NT-proBNP,and D-Dimer,critical illness were associated with atrial flutter or atrial fibrillation in COVID-19 patients(P all<0.05).Multivariate logistic regression analysis showed that hypertension,elevated cTnI and critical illness were the independent related factors of sinus tachycardia in COVID-19 patients(P all<0.05).Age and elevated NT-proBNP were the independent related factors of atrial flutter or atrial fibrillation in COVID-19 patients(P all<0.05).Conclusions:Patients with COVID-19 are prone to arrhythmia.Common arrhythmias are sinus tachycardia,atrial flutter or atrial fibrillation.Myocardial injury,history of hypertension,and critical illness are the main reasons for sinus tachycardia in COVID-19 pati

关 键 词：2019冠状病毒疾病 危重症 心电图 心律失常 

分 类 号：R541.7[医药卫生—心血管疾病]