不同心电图检查设备定位诊断流出道型室性早搏的效果对比研究  

Comparative effectiveness research of different equipment of electrocardiogram examination in locational diagnosis of outflow tract type of PVC

作　　者：张田田[1] 梁玲娣[1] 孙静[1] 陈燕[1] ZHANG Tian-tian;LIANG Ling-di;SUN Jing(Functional Department,Liuzhou People's Hospital,Liuzhou 545006,China)

机构地区：[1]柳州市人民医院功能科,广西柳州545006

出　　处：《中国医学装备》2022年第10期93-97,共5页China Medical Equipment

基　　金：广西卫生厅自筹课题(z20170699)“‘倒Y字’心电散点图与2型糖尿病心脏自主神经病变的相关性研究”。

摘　　要：目的:对比研究常规心电图(ECG)、霍尔特氏心电动态监测(Holter ECG monitor)和多导心电图(MLE)3种心电图检查设备定位诊断流出道型室性早搏(PVC)的临床价值。方法:选取在医院心内科接受经导管射频消融术(RFCA)的106例流出道型PVC患者,治疗前均进行ECG、Holter及MLE检查;以RFCA术中心脏电生理标测结果作为“金标准”,以V2R波振幅指数和时限指数、胸导联移行区、SV2/RV3及V2移行指数作为定位诊断参数,采用Kappa检验分析3种ECG检查方法诊断的一致性,比较3种检查方法对流出道型PVC的定位诊断性能。结果:RFCA术后诊断显示106例患者中右室和左室流出道型PVC分别为85例(占80.19%)和21例(占19.81%)。以V2R波振幅和时限指数、V2移行指数作为参数,ECG的Kappa值分别为0.526和0.562,Holter的Kappa值分别为0.547、0.519,MLE的Kappa值分别为0.533和0.548,定位诊断与RFCA术后诊断右室和(或)左室流出道型PVC之间均具有中等一致性;ECG、Holter及MLE的定位诊断灵敏度、特异度比较差异均无统计学意义。以胸导联移行区为参数,ECG和MLE定位诊断与RFCA术后诊断右室和(或)左室流出道型PVC之间均存在高度一致性,Kappa值分别为0.728和0.695;ECG及MLE的定位诊断灵敏度均明显高于Holter,差异有统计学意义(x^(2)=4.08,x^(2)=5.32;P<0.05),而特异度均明显低于Holter,差异有统计学意义(x^(2)=3.99,x^(2)=4.23;P<0.05)。以SV2/RV3为参数,ECG和MLE定位诊断与RFCA术后诊断右室和(或)左室流出道型PVC之间均存在完全一致性,Kappa值为0.849和0.837;ECG及MLE的定位诊断灵敏度均明显高于Holter,差异有统计学意义(x^(2)=3.96,x^(2)=4.01;P<0.05),而特异度均明显低于Holter,差异有统计学意义(x^(2)=5.21,x^(2)=4.32;P<0.05)。结论:ECG及MLE对流出道型PVC的定位诊断性能优于Holter,胸导联移行区及SV2/RV3可以作为流出道型PVC的有效定位诊断参数。Objective: To compare the clinical value of routine electrocardiogram(ECG), Holter monitor(Holter) and multi-lead electrocardiogram(MLE) in the locational diagnosis of outflow tract type of premature ventricular contractions(PVC). Methods: A total of 106 patients with outflow tract type of PVC who underwent radio-frequency catheter ablation(RFCA) in the department of cardiology of our hospital were selected. Before treatment, all patients underwent ECG, Holter and MLE examination. The diagnostic results of intraoperative cardiac electrophysiology of RFCA were used as the gold standard. The V2R wave amplitude index and time limit index, thoracic lead transition region, SV2/RV3 and V2 transition index were used as diagnostic parameters of location. The Kappa coefficient was used to analyze the diagnostic consistency of three kinds of ECG methods, and the diagnostic performances of location of them were compared for the location of outflow tract type of PVC. Results: The postoperative diagnosis of RFCA showed 85 cases(80.19%) were right ventricular and 21 cases(19.81%) were left ventricular outflow tract type of PVC in 106 patients, respectively. When V2R wave amplitude index and time limit index, V2 transition index were used as the parameters, the Kappa values of ECG were 0.526 and 0.562 on them, respectively. And the Kappa values of Holter were 0.547 and 0.519 on them, respectively. And the Kappa values of MLE were 0.533 and 0.548 on them, respectively.There was middle consistency between locational diagnosis and RFCA postoperative diagnosis on right ventricular/left ventricular outflow tract type of PVC. The differences of diagnostic sensitivity and specificity of location among ECG, Holter and MLE were no significant. There were high consistency in the locational diagnoses between ECG and RFCA postoperative diagnosis, and between MLE and RFCA for right ventricular/left ventricular outflow tract type of PVC when took thoracic lead transition region as the parameter(Kappa value ECG=0.728, Kappa value MLE=0.695).

关 键 词：流出道型 室性早搏(PVC) 定位诊断 常规心电图(ECG) 霍尔特氏心电动态监测(Holter) 多导心电图(MLE) 比较效果研究(CER) 

分 类 号：R541.7[医药卫生—心血管疾病]