参考心电向量T环评估心血管风险的临床研究

Clinical Studies to Evaluate the Cardiovascular Risk by T Ring VCG

目的研究不同分级不稳定型心绞痛患者心电向量T环的特征,探讨用T环作为鉴别诊断的方法。方法选取2005年12月至2014年12月海口市人民医院收治的不稳定型心绞痛且有T环向量异常的患者146例作为研究对象,其中48 h内有反复静息心绞痛发作患者73例作为高危组,48 h内无而1个月内有静息心绞痛反复发作患者73例作为中危组,总结上述病例心绞痛发作前和发作时心电向量T环在额面、横面、右侧面三个面的状态(参考指标:QRS-T夹角、T环面积、T环形态)及转变。结果高危组或中危组的心电向量T环分别在额面、横面、右侧面三个面的参考指标组内相比较,各个组三个面之间的差异无统计学意义(P>0.05);高危组和中危组的心电向量T环在额面或横面或右侧面某一面的图形变换组间比较,在任一面两组的差异有统计学意义(P<0.05)。1高危组额面、横面、右侧面R-T夹角最大变化量差≥5°的发生率显著高于中危组(86.3%比12.3%,90.4%比17.8%,83.6%比11.0%,P<0.01);2高危组额面、横面、右侧T环面积最大变化量差≥2 mm2的发生率显著高于中危组(89.0%比8.2%,93.2%比5.5%,86.3%比11.0%,P<0.01);3高危组额面、横面、右侧T环扭结数差≥2个的发生率显著高于中危组(93.2%比13.7%,95.9%比8.2%,90.4%比17.8%,P<0.01)。结论心电向量T环是有效评估心血管风险的可考量的指标。

Objective To research the characteristics of vectoreardiogram T ring VCG of unstable angina patients of different grades, to discuss the differential clinical diagnosis with T ring. Methods The study selected 146 cases of unstable angina pectoris and abnormal T vector in Haikou City People＇s Hospital from Dec. 2005 to Dec. 2014,including 73 cases in high risk group with recurrent quiet angina within 48 hours, and 73 cases in intermediate risk group with recurrent quiet angina in 1 month but not within 48 hours. The changed state of T ring VCG（ reference indicators ： QRS-T angle ,T ring area,T ring shape） on the three faces （ frentalis, horizontal, right side） in these case were summarized. Results The changed state of T ring VCG respectively among the three faces （ frontalis, horizontal surface, right side ） had no statistically significant difference （ P 〉 0.05 ） in the intermediate risk group or high risk group ;the changed state of T ring VCG on any of the three faces between the two groups had statistically significant difference （ P 〈 0.05 ）. ①The incidence of R-T angle maximum differential variation ≥5° in the high risk group was significantly higher than in the intermediate risk greup（ 86. 3% vs 12.3% ,90.4% vs 17.8% ,83.6% vs 11.0% ,P〈0.01） ; ②The incidence of T area maximum differential variation ≥2 mm2 ,in the high risk group was signifieantly higher than in the intermediate risk group（89.0% vs 8.2% ,93.2% vs 5.5% ,86.3% vs 11.0% ,P 〈 0. 01 ） ; ③The incidence of T ring kink differential number≥2 in the high risk group was significantly higher than in the intermediate risk group（93.2% vs 13.7% ,95.9% vs 8.2% ,90.4% vs 17.8% , P 〈 0.01 ）. Conclusion T ring VCG is an effective measurable assessment indicator of cardiovascular risk.