心电图联合超声心动图检查对不同程度冠心病心力衰竭患者的临床诊断价值

Value of Electrocardiogram Combined with Echocardiography in Diagnosis of Different Degrees of Coronary Heart Disease Patient with Heart Failure

目的探讨心电图联合超声心动图检查对不同程度冠心病心力衰竭患者的临床诊断价值。方法选取2013年3月—2015年9月在清河县中心医院住院治疗的符合纳入及排除标准的冠心病心力衰竭214例,按左室射血分数(LVEF)分为A、B、C 3组,A组LVEF<30%48例,B组LVEF 30%~40%74例,C组LVEF 40%~49%92例,观察比较3组心电图检查时QRS电压值、QRS时限值、QTc间期及超声心动图检查时左心室舒张末期内径(LVEDD)、左房内径(LA),并统计比较3组心电图异常类型及预后。结果 3组QRS电压值、QRS时限值、QTc间期、LVEDD、LA及窦性心动过速、房室早搏、室性早搏、ST-T段改变、QT间期延长、心房颤动、Q波异常、左前支阻滞发生率总体比较差异均具有统计学意义(P<0.05)。3组随着冠心病心力衰竭程度加重,QRS电压值逐渐降低,QRS时限值和QTc间期逐渐增高,LVEDD、LA逐渐延长,3组间各指标两两比较差异均有统计学意义(P<0.05)。窦性心动过速、房室早搏、室性早搏、ST-T段改变、QT间期延长、心房颤动、Q波异常、左前支阻滞发生率A组均高于B、C组,差异有统计学意义(P<0.05)。214例中共死亡16例,死亡时间为入院后1~3 d,其中A组死亡12例,B组死亡3例,C组死亡1例。结论冠心病心力衰竭患者随着病情加重,QRS电压值逐渐降低,QRS时限值和QTc间期逐渐增高,LVEDD、LA逐渐延长。心电图联合超声心动图检查对冠心病心力衰竭的临床诊断极有帮助,临床可根据QRS电压值、QRS时限值、QTc间期、LVEDD及LA的变化来评估此类患者病情。

Objective To investigate value of electrocardiogram combined with echocardiography in diagnosis of different degrees of coronary heart disease patients with heart failure. Methods A total of 214 coronary heart disease patients withheart failure admitted during March 2013 and September 2015 were recruited in this study,who had inclusion and exclusionstandard,and the patients were divided into group A （ n = 48,LEVF 〈 30% ） ,group B （ n = 74,30% 〈 LEVF 〈 40% ）andgroup C （ n = 92,40% 49% of LEVF）according to left ventricular ejection fraction （ LVEF）scores. In three groups,levels ofleft ventricular enddiastolic dimension （ LVEDD）left atrial diameter （ LA）during echocardiographic test,and voltage,limitvalues of QRS and QTc interval value during electrocardiogram detection were observed and compared,and abnormal echocardiographic types and prognoses were analyzed and compared. Results There were significant differences in LVEDD,LA,voltageand limit values of QRS,QTc interval value,and incidence rates of sinus tachycardia,atrial premature beat,ventricular premature beat,STT segment change,QT interval prolongation,atrial fibrillation,abnormal Q wave and left anterior branch block（ P 〈 0 05） . In the three groups,LVEDD and LA levels were gradually increased;QRS voltage values were gradually decreased;QRS limit and QTc interval values were gradually increased with aggravating heart failure degree in patients with coronary heart disease,and the differences in each index between every two groups were statistically significant （ P 〈 0.05） . Incidence rates of sinus tachycardia,atrial premature beat,ventricular premature beat,STT segment change,QT interval prolongation,atrial fibrillation,abnormal Q wave and left anterior branch block were significantly higher in group A than those in groupB and C （ P 〈 0.05） . Among the 214 patients,16 patients were death,and the death time was at 1st） 31rdd after admission,and there were 12 cases in group A,3 cases in group B and 1 cases in group C. Conclusion LVEDD and LA levels can befound gradually increased,and QRS voltage values can be found gradually decreased,and QRS limit and QTc interval values canbe found gradually increased with aggravating heart failure degree in patients with coronary heart disease. Echocardiography combined with electrocardiogram is helpful in clinical diagnosis of coronary heart disease patients with heart failure,and cliniciansmay evaluate patient＇ s condition by change of LVEDD,LA,QRS voltage value,QRS limit and QTc interval changes.