同步12导联动态心电图诊断冠心病心肌缺血的价值研究  

The study on the value of synchronized 12-lead Holter in the diagnosis of coronary heart disease myocardial ischemia

作　　者：刘苏城 吕新[1] 李良军[1] Liu Sucheng;Lyu Xin;Li Liangjun(Department of Electrocardiogram Room,the Affiliated Hospital of Jining Medical College,Jining,272029,China)

机构地区：[1]济宁医学院附属医院心电图室,济宁272029

出　　处：《中国医师进修杂志》2022年第2期171-174,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨同步12导联动态心电图诊断冠心病心肌缺血的临床价值。方法选取2019年5月至2020年5月在济宁医学院附属医院就诊的101例冠心病患者, 均接受常规心电图、同步12导联动态心电图检查, 比较不同检查方法诊断冠心病心肌缺血的价值, 分析不同程度冠状动脉病变患者心肌缺血发作特点。结果同步12导联动态心电图对单支冠状动脉病变、多支冠状动脉病变心肌缺血检出率分别为28.71%(29/101)、56.44%(57/101), 略高于常规心电图的17.82%(18/101)、45.54%(46/101), 但差异无统计学意义(P>0.05);12导联动态心电图心肌缺血总检出率为85.15%(86/101), 高于常规心电图的63.37%(64/101), 差异有统计学意义(P<0.05)。同步12导联动态心电图诊断冠心病心肌缺血平均发作频次高于常规心电图, ST段压低持续时间、压低幅度均高于常规心电图(P<0.05)。同步12导联动态心电图对侧壁及下壁心肌缺血检出率分别为16.28%(14/86)、22.09%(19/86), 以上两个部位心肌缺血常规心电图检出率均为0。同步12导联动态心电图对前间壁/前壁心肌缺血检出率为61.62%(53/86), 低于常规心电图的100.00% (64/64), 差异有统计学意义(P<0.01)。同步12导联动态心电图诊断冠心病心肌缺血与冠状动脉造影一致性较高, Kappa值为0.648, 灵敏度、特异度、准确率、阴性预测值分别为93.33%、81.82%、92.08%、60.00%。同步12导联动态心电图诊断冠心病多支病变患者心肌缺血发作例数较单支病变患者多(P<0.05), 心肌缺血发作频次高于单支病变患者, ST段压低持续时间、压低幅度均高于单支病变患者(P<0.05)。结论同步12导联动态心电图诊断冠心病心肌缺血发作效能较常规心电图高, 与冠状动脉造影一致性更高, 可明确心肌缺血发作频率及程度, 有助于识别心肌缺血部位。Objective To explore the clinical value of synchronized 12-lead Holter in the diagnosis of coronary heart disease myocardial ischemia.Methods A total of 101 patients with coronary heart disease who came to the Affiliated Hospital of Jining Medical College from May 2019 to May 2020 were selected.They all received conventional electrocardiogram(ECG)and synchronized 12-lead Holter examinations.The value of different examination methods in the diagnosis of myocardial ischemia was compared,and the characteristics of myocardial ischemia in patients with different degrees of coronary artery disease were analyzed.Results The detection rates of synchronized 12-lead Holter for myocardial ischemia in single-vessel coronary artery disease and multi-vessel coronary artery disease were 28.71%(29/101)and 56.44%(57/101),respectively,which were slightly higher than 17.82%(18/101)and 45.54%(46/101)of conventional ECG,but with no statistically significant difference(P>0.05),the total myocardial ischemia detection rate of synchronized 12-lead Holter was 85.15%(86/101),which was higher than 63.37%(64/101)of conventional ECG(P<0.05).The mean frequency of myocardial ischemia in coronary heart disease diagnosed by synchronized 12-lead Holter was higher than that of conventional ECG,and the duration and amplitude of ST-segment depression were higher than those in conventional ECG(P<0.05).The detection rates of lateral and inferior myocardial ischemia on synchronized 12-lead Holter were 16.28%(14/86)and 22.09%(19/86),respectively,which were higher than 0 of conventional ECG.The detection rate of myocardial ischemia in the anterior septum/anterior wall was 61.62%(53/86),which was lower than 100.00%(64/64)of the conventional ECG(P<0.01).Synchronized 12-lead Holter in the diagnosis of coronary cardiac myocardial ischemia was highly consistent with that by coronary angiography,the Kappa value was 0.648,and the sensitivity,specificity,accuracy and negative predictive value were 93.33%,81.82%,92.08%and 60.00%,respectively,which were higher than

关 键 词：心电描记术 便携式 冠状动脉疾病 心肌缺血 诊断 

分 类 号：R541.4[医药卫生—心血管疾病]