动态心电图应用于重症阻塞性睡眠呼吸暂停低通气综合征术前评估的价值

The value of dynamic electrocardiogram in preoperative evaluation of patients with severe obstructive sleep apnea hypopnea syndrome

目的探讨动态心电图在重症重度阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)患者术前评估中的应用价值。方法对60例重度OSAHS患者术前同步行常规心电图(electrocardiogram,ECG)及24h动态心电图(dynamic electrocardiogram,DCG)检查,比较两者检查心律失常、心肌缺血和复合性心电异常的阳性率。结果60例患者术前BMI中位数为50.1 kg/m^2,术前呼吸暂停低通气指数(apnea hypopnea index,AHI)中位数为58.6次/h;术前最低血氧饱和度中位数为43%。ECG与DCG检查结果阳性率分别为43.3%及85.0%(P<0.01);单项阳性率:各种类型心律失常为15.0%和28.3%(P=0.023),心肌缺血为25.0%和51.7%(P=0.017),复合性心电异常为3.30%和8.30%(P=0.033)。参照动态心电图结果,术前行临时起搏器安置术6例,围手术期营养心肌治疗31例。60例患者中接受手术治疗49例,均安全度过围手术期,未发生严重心血管并发症。结论 DCG用于重度OSAHS术前评估可有效帮助发现睡眠期心电异常,有助于减少围手术期心血管并发症的发生。

Objective To investigate the diagnostic value of dynamic electrocardiogram（ DCG） and electrocardiogram（ ECG） in patients with severe obstructive sleep apnea hypopnea syndrome（ OSAHS）. Methods DCG and ECG were performed in 60 severe OSAHS patients,and the detection rates of myocardial ischemia,arhythmia and compound ECG abnormalities were compared between two methods. Results The median BMI was 50. 1 kg/m^2 before operation,AHI was 58. 6 times/h,and the lowest oxygen saturation was43%. Positive detection rates was 43. 3% and 85. 0% by ECG and DCG,respectively（ P〈0. 01）. Positive rates were 15. 0% and28. 3% for arhythmia by ECG and DCG,respectively（ P = 0. 023）,25. 0% and 51. 7% for myocardial ischemia（ P = 0. 017） and3. 30% and 8. 30% for complex ECG abnormalities（ P = 0. 033）. According to DCG,temporary pacemaker was placed in 6 patients before operation,and 31 patients were perioperatively treated by myocardial nutrition. Of 60 patients,49 carried out the operation and no cardiovascular complications were found during the peri-operation. Conclusion DCG can effectively observe the cardiovascular abnormalities of patients with severe OSAHS before operation,and it is helpful to reduce the incidence of perioperative cardiovascular complications.