心电图在招飞体检中的应用与登梯运动试验方法改进探讨

Electrocardiology in Physical Examination of Flying Cadets and Improvement of Ladder Exercise Test

目的通过招飞体检学生心电图及登梯运动试验情况，评价招飞体检现行的心功能评定方法的优劣，为改进心功能试验方法提供依据。方法使用日本光电9620P型12导联心电图机，描记2004-2009年招飞体检学生静息状态下常规12导联心电图，结果正常者按照《空军招收飞行学员体格检查方法》进行登梯运动试验，3min后平卧位观察记录其运动后2min时心电图。必要时4min、6rain时心电图各波群。分类统计分析，探讨影响因素。结果6957名招飞体检学生中，有450人（6．47％）不符合招飞条件被淘汰。排在淘汰原因前三位依次是心律失常（38．44％）、ST—T改变（25．78％）心电轴左右偏移（24．00％）。其中静息心电图不合格261人，淘汰率占总检测人数的3．75％。排在淘汰原因前三位依次是心电轴左右偏移（41．38％）、心律失常（39．08％）、T波改变（14．18％）。登梯运动试验不合格189人，淘汰率占总检测人数的2．72％。排在淘汰原因前两位依次是ST—T改变（61．38％）、心律失常（37．57％），以室性早搏多见。与静息心电图检查相比，登梯运动试验增加了淘汰率（χ2=45．22，P〈0．01）。结论登梯运动试验在招飞体检中发挥了重要作用，但运动负荷量不足、不能同时监测运动中血压，心功能运动试验方法需进一步改进，建议招飞体检采用次极量平板运动试验。

Objective By summarizing the electrocardiology （ECG） and the ladder exercise test results of flying ca- dets to evaluate the problems and conditions of present cardiac function assessment method, and provide the basis for im- provement of heart function test methods. Methods The electrocardiogram of the cadets between 2004 and 2009 were re- corded in the resting state by Nihon Kohden 9620P 12-lead ECG. According to the ＂Air Force flying cadet recruit physical examination methods＂, students with normal ECG underwent 3 minutes of ladder exercise test. The ECG at 2 minutes af- ter exercise was obtained. If necessary, 4 rain, 6 rain electrocardiogram were also recorded. The influential factors were analysed. Results In 6957 cadets, 450 （6. 47%） didn＇t meet the recruit standards and were eliminated. The top three elimination reasons were arrhythmia （38. 44%）, ST-T changes （25.78%）, and ECG axis offset （24. 00%）. Among them, 261 students （3.75% of the total students） were eliminated because of unqualified resting ECG. The top three elimination reasons were ECG axis offset （41.38%）, arrhythmia （39. 08%）, and T wave changes （14. 18%）. A total of 189 students （2. 72% of the total students） were failed in ladder exercise test. The top two elimination reasons were ST- T changes （61.38%）, and arrhythmia （37. 75%）, mostly premature ventricular contractions. Compared with resting ECG, ladder exercise test significantly increased the elimination rate （χ2 = 45.22, P〈0. 01）. Conclusion Ladder exer- cise test is a useful method in the physical examination of the cadets. But it＇s disadvantage including insufficient exercise load, lack of simultaneous monitoring for blood pressure during exercise, and heart function exercise test methods need to be further improved. It＇s recommended to apply submaximal treadmill exercise test for cadet recruit.