急性脑血管病动态心电图的临床分析

Clinical study on dynamic electrocardiogram of acute cerebrovascular disease

目的探讨急性脑血管病患者动态心电图的临床意义。方法选取50例急性脑血管病患者作为观察组,另选50例健康者作为对照组,行常规心电图和动态心电图检查,对比急性脑血管病患者心电图及动态心电图异常检出率;比较急性脑血管病患者与对照组动态心电图异常检出率差异;分析急性脑血管病患者与健康对照组心率变异性(heart rate variability,HRV)时域指标(SDNN、SDNAA、rMSSD)的差异性。结果急性脑血管病患者动态心电图异常检出率明显高于心电图;急性脑血管病组心律失常检出率明显高于对照组;急性脑血管病组HRV时域指标rMSSD明显低于对照组,SDNN、SDNAA低于对照组。结论急性脑血管病患者心律失常以阵发复杂性心律失常包括各种偶发与频发早搏、短阵房速与房颤、短阵室性心动过速、房室阻滞为主。动态心电图可提高急性脑血管病患者阵发性、突发性、复杂性及危险性心电检出率,对心律失常的定性及HRV的定量分析可为急性脑血管病时心脏损伤的诊断、评估和治疗提供更全面可靠的信息。

Objective To explore the clinical significance of dynamic electrocardiogram（DCG） of patients with acute cerebrovascular disease（ACVD）. Methods Enroll 50 ACVD cases into observation group and another 50 healthy cases into control group. Execute routine electrocardiogram （ECG） and DCG exami- nation upon both of the two groups. For the observation group, compare the abnormity detection rates by ECG with those by DCG. Between the two groups, find out the difference of abnormity detection rates by DCG and analyse the differences of heart rate variability （HRV） time domain indexes （SDNN, SDNAA, rMSSD）. Results For ACVD patients, their abnormity detection rates by DCG were significantly higher than those by ECG and their detection rates of arrhythmia were significantly higher than those of control group. In the aspect of HRV time domain indexes, rMSSD of the observation group was significantly lower than thai of the control group while SDNN and SDNAA were lower too. Conclusion Arrhythmias among ACVD patients usually express as paroxysmal complex arrhythmias including occasional and recurrent atrial premature beat, paroxysmal atrial taehyeardia and paroxysmal atrial fibrillation, paroxysmal ventrictdar heartbeat tachyeardia and various atrioventricular blocks. Compared with ECG, DCG could raise the detection rates of paroxysmal, sudden, complex and fatal arrhythmias for ACVD patients. The qualitative analysis of arrhythmia and quantitative analysis of HRV by DCG could provide more comprehensive and reliable information for the diagnosis, evaluation and treatment of heart injury in the attack of ACVD.