EASI 12导联与标准监护Ⅱ导联监测心肌缺血的观察

Comparison of EASI 12-lead electrocardiogram and standard monitor lead H electrocardiogram in de-tecting myocardial ischemia

目的评价目前常规选择的标准监护Ⅱ导联和EASI12导联心电监测对于发现心肌缺血的有效性和敏感性。方法采用诊断试验的评价研究设计，将研究期间收住北京市宣武医院CCU病房的57例有ST段改变的病人作为病例组，43例无ST段改变的病人作为非病例组，选用标准12导联心电图为金标准，评价CCU标准监护Ⅱ导联和EASI12导联发现心肌缺血的有效性和敏感性。两组病人均同时描记标准12导联、EASI12导联和标准监护Ⅱ导联心电图。比较3种心电图中ST段的改变情况。结果标准监护Ⅱ导联心肌缺血检出率明显低于标准12导联心电图，敏感度、特异度、假阳性率和假阴性率分别为24．6％、95.3％、4.7％和75.4％，一致性检验Kappa值仅为0.178。而EASI12导联对心肌缺血的检出率与标准12导联心电图相仿，敏感度、特异度、假阳性率和假阴性率分别为89.5％、97．7％、2.3％和10．5％，Kappa=0．859。结论临床上通常选用的标准监护Ⅱ导联并不能有效地发现心肌缺血，而EASI12导联较标准Ⅱ导联能够更有效地发现心肌缺血，具有较好的敏感度和特异度。

Objective To evaluate the effectiveness and sensitivity of EASI 12-lead electrocardiogram （ECG） and standard monitor lead II ECG in detecting myocardial ischemia. Methods Diagnostic test evaluation design was used. Patients who were admitted to Xuanwu Hospital Cardiac Care Unit （CCU） were recruited for this pilot study and divided into ST-segment deviation group （n=57） and non-ST-segment deviation group （n=43） according to standard 12-lead ECG findings （golden standard）. Standard 12-lead ECG, standard monitor lead II ECG strip and EASI 12-lead ECG were recorded simultaneously and ST segment deviation was compared. Results Monitor with standard lead II only had a lower detection rate of myocardial ischemia than standard 12-lead ECG, with a sensitivity and specificity of 24.6% and 95.3%, respectively, and the false negative rate is as high as 75.4% with a Kappa value of 0.178. The EASI 12-lead ECG had a good con-sistency with standard 12-lead ECG in detecting myocardial ischemia with a Kappa value of 0.859, sensitivity and specificity of 0. 859, 89.5% and 97. 7%, respectively, and a false negative rate of 10. 5%. Conclusion Standard monitor lead II , which is frequently selected by CCU nurses to monitor acute coronary syndrome patients usually can not detect myocardial ischemia effectively while the EASI 12-lead ECG is compatible with standard 12-lead ECG in detecting myocardial ischemia, indicating that monitor with EASI 12-lead ECG will more effectively detect myocardial ischemia than using standard monitor lead II only.