入院时24 h动态心电图参数联合检测对肺心病患者发生呼吸衰竭的预测价值  

Predictive value of combined detection of 24-hour dynamic electrocardiogram parameters at admission for respiratory failure in patients with pulmonary heart disease

作　　者：肖虹 王庆义[2] 朱卫华 XIAO Hong;WANG Qing-yi;ZHU Wei-hua(Department of Cardiopulmonary Function,Zhengzhou Yihe Hospital,Zhengzhou 450018,Henan,CHINA;Department of Cardiopulmonary Function,Henan Provincial People's Hospital,Zhengzhou 450000,Henan,CHINA;Department of Respiratory Medicine,Zhengzhou Yihe Hospital,Zhengzhou 450018,Henan,CHINA)

机构地区：[1]郑州颐和医院心肺功能科,河南郑州450018 [2]河南省人民医院心肺功能科,河南郑州450000 [3]郑州颐和医院呼吸内科,河南郑州450018

出　　处：《海南医学》2025年第4期471-475,共5页Hainan Medical Journal

基　　金：2020年度河南省医学科技攻关计划联合共建立项项目(编号:LHGJ20209089)。

摘　　要：目的探讨入院时24 h动态心电图参数与肺心病患者心肺功能指标的相关性及24 h动态心电图参数联合检测对肺心病患者呼吸衰竭发生的预测价值。方法前瞻性选取2021年8月至2023年8月郑州颐和医院收治的118例肺心病患者纳入研究,出院后随访6个月,根据是否发生呼吸衰竭分为发生组27例和未发生组91例。比较两组患者的右心室射血分数(EFRV)、血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、第1秒用力呼气容积/用力肺活量(FEV1/FVC)及24 h动态心电图参数P波异常改变、ST段异常改变、平均R-R间期标准差(SDNN)、每5 min时段正常R-R间期标准差(SDANN)、低频成分/高频成分(LF/HF);采用Pearson相关性分析入院时24 h动态心电图参数与肺心病患者心肺功能指标的相关性;采用受试者工作特征(ROC)曲线分析24 h动态心电图参数P波异常改变、ST段异常改变、SDANN、SDNN、LF/HF联合检测对肺心病患者发生呼吸衰竭的预测效能。结果发生组患者入院时EFRV、PaO_(2)、FEV1/FVC分别为(32.24±3.10)%、(54.12±4.26)mmHg、(53.12±3.22)%,明显低于未发生组的(35.67±3.37)%、(60.01±4.79)mmHg、(57.86±3.75)%,PaCO_(2)为(65.57±5.60)mmHg,明显高于未发生组的(60.28±4.38)mmHg,差异均有统计学意义(P<0.05);发生组患者入院时P波异常改变、ST段异常改变比例分别为66.67%、74.07%,明显高于未发生组的13.19%、16.48%,SDNN、SDANN、LF/HF分别为(82.53±8.63)ms、(71.26±8.03)ms、1.31±0.16,明显低于未发生组的(89.14±10.41)ms、(78.95±9.77)ms、1.47±0.21,差异均有统计学意义(P<0.05);Pearson相关性分析结果显示,入院时P波异常改变、ST段异常改变与FEV1/FVC、EFRV、PaO_(2)呈负相关(P<0.05),与PaCO_(2)呈正相关(P<0.05),SDANN、SDNN、LF/HF与FEV1/FVC、EFRV、PaO_(2)呈正相关(P<0.05),与PaCO_(2)呈负相关(P<0.05);ROC曲线分析结果显示,入院时P波异常改变、ST段异常改变、SDNN、SDANN、LF/HF联合检测预测肺心病并Objective To investigate the predictive value of combined detection of 24-hour dynamic electrocardiogram parameters at admission for respiratory failure in patients with pulmonary heart disease.Methods A total of 118 patients with pulmonary heart disease admitted to Zhengzhou Yihe Hospital from August 2021 to August 2023 were selected prospectively.The patients were followed up for 6 months after discharge,and they were divided into a occurrence group(27 cases)and non-occurrence group(91 cases)according to whether respiratory failure occurred.Ejection fraction of right ventricle(EFRV),partial pressure of oxygen in blood(PaO_(2)),partial pressure of carbon dioxide in blood(PaCO_(2)),forced expiratory volume in one second/forced vital capacity(FEV1/FVC),24-hour dynamic electrocardiogram parameters(P-wave abnormalities,ST segment abnormalities,standard deviation of mean R-R interval[SDNN],standard deviation of normal R-R interval per 5-minute period[SDANN],low-frequency component/high-frequency component[LF/HF])were compared between the two groups.The relationship of 24-hour dynamic electrocar-diogram parameters with cardiopulmonary function was analyzed by Pearson,and receiver operating characteristic(ROC)curve was used to analyze the predictive efficacy of combined detection of 24-hour dynamic electrocardiogram parameters(P-wave abnormalities,ST segment abnormalities,SDANN,SDNN,LF/HF)for respiratory failure in patients with pulmonary heart disease.Results At admission,EFRV,PaO_(2),and FEV1/FVC in the occurrence group were(32.24±3.10)%,(54.12±4.26)mmHg,and(53.12±3.22)%,respectively,which were significantly lower than(35.67±3.37)%,(60.01±4.79)mmHg,and(57.86±3.75)%in the non-occurrence group;PaCO_(2)was(65.57±5.60)mmHg,which was sig-nificantly higher than(60.28±4.38)mmHg in the non-occurrence group;the differences were statistically significant(P<0.05).The proportion of P-wave abnormalities and ST segment abnormalities in the occurrence group were 66.67%and 74.07%,respectively,which were significantly higher

关 键 词：肺心病 呼吸衰竭 24 h动态心电图参数 心肺功能指标 预测价值 

分 类 号：R541.5[医药卫生—心血管疾病]