动态心电图仪故障引起误诊断原因分析

Analysis of misdiagnosis resulting from the malfunction of ambulatory electrocardiography recorder.

目的通过临床发现的动态心电图仪故障导致无心律失常患者误诊误治的病例,提出动态心电图记录器潜在的问题,提醒动态心电图医师和技师,在分析动态心电图时应注意相似结果的病例,及时发现有故障的记录器。减少因仪器故障导致的误诊误治病例。方法两家医院2004年2月患者的动态心电图时发现4组病例的图形、结果相同。其中男6例,女4例,年龄23～68岁(平均43.3岁)。4组心律失常诊断:①阵发性心房扑动伴21下传,阵发性室性心动过速,室性早搏;②不纯性心房扑动伴长R-R间期;③频发性室性早搏;④二度房室阻滞,短阵室性心动过速,频发性室性早搏。结果应用另一厂家的动态心电图仪复查,检查结果完全不同。检测动态心电图记录器后发现3组患者所佩带的闪光卡记录器存在间断供电中断导致数据写入异常。1组患者可能为软件下载路径错误导致患者本身病例未能正常调出,而误调出示教病例。结论动态心电图仪故障可分为硬件故障和软件故障,硬件故障主要可见:①闪光卡损坏;②记录器或电池供电量不足。软件故障包括:①记录器清除数据不全;②软件下载路径发生错误等。需要及时与厂家联系,可避免故障连续发生,降低不必要的损失。提出重视并及时发现各种故障是临床和动态心电图医师与技师重要的职责。

Objectives To improve the ability of physician and technicians of ambulatory electrocardiography unit to identify the malfunction. of ambulatory electrocardiography recorder,avoiding the misdiagnosis and inapprociate treatment of the patients without arrhythmias. Methods Four types of similar arrhythmias with the same results were recorded in 10 patients of 2 hospitals in February,2004, including 6 male patients and 4 female patients, the range of ages is between 23 to 68 years old ( average 43.3 years old). The four types arrhythmias are 1Paroxysmal atrial flutter with 2:1 conduction, paroxysmal ventricular tachycardia and ventricular premature contraction 2Impure atrial flutter with long R-R interval.3Frequent ventricular premature contraction4Second degree atrioventricular block, paroxysmal ventricular tachycardia and frequent ventricular contraction. Results the patients were tested by the other brand Holter system and no arrthymias were recorded. The recorders were examined and in 3 groups the power supplies of the flash recorder were intermittently interrupt.In another group the misdiagnosis may be resulted from the improper software download pathway and the former demonstrative result was reviewed. Conclusion The malfunctions of ambulatory electrocardiography recorder consisted of hardware and software malfunction. Hardware problems includes damages of flash card and low power supplies of recorder or battery. Software problems consist of data deleting problems and the mistakes of software download pathway. It is the duty of physicians and technicians to discover the malfunction of recorders to avoid the misdiagnosis and inapprociate treatment of the patients.