超声心动图联合动态心电图检查对急性心肌梗死诊断和预后评估的价值

Application Value in Diagnosis and Prognosis Evaluation of Echocardiography and Dynamic Electrocardiogram Examination in Patients with Acute Myocardial Infarction

为探讨超声心动图联合动态心电图检查在急性心肌梗死(AMI)患者诊断和预后评估中的应用价值,本研究选取2016年6月~2018年6月我院收治并确诊的100例AMI患者作为观察组,另选取同期100例非冠心病患者作为对照组。以AMI患者心源性死亡为终点事件,将观察组分为死亡组(n=15)和存活组(n=85)。所有患者均采用飞利浦IU-Elite及EPIQ5彩色多普勒超声诊断仪进行超声心动图检查,采用DMS-3004A进行标准的12导联动态心电图检查。比较各组患者心率震荡指标[震荡起始(TO)、震荡斜率(TS)]、心率变异性指标[NN间期标准差(SDNN)、QT离散度(QTd)、经心率校正的QT离散度(QTcd)]及心功能指标[左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)]水平的变化。结果显示,观察组TO、QTd、QTcd、LVEDD均明显高于对照组,TS、SDNN、LVEF均明显低于对照组,差异有统计学意义(P<0.05)。死亡组TS、SDNN均明显低于存活组,差异有统计学意义(P<0.05);死亡组TO高于存活组,QTd、QTcd、LVEF、LVEDD均低于存活组,但差异无统计学意义(P>0.05)。本研究结果表明,AMI患者心率震荡(HRT)明显减弱甚至消失,HRV、LVEF明显降低,LVEDD、QTd明显增大,QT间期明显延长。超声心动图和动态心电图联合检查对AMI患者诊断及预后评估均有重要的临床应用价值。

To investigate the application value in diagnosis and prognosis evaluation of echocardiography and dynamic electrocardiogram examination in patients with acute myocardial infarction(AMI),100 AMI patients admitted and diagnosed in our hospital from June 2016 to June 2018 were selected as the observation group,and 100 patients without coronary heart disease in the same period were selected as the control group.Cardiac death was the end point of AMI,the observation group was divided into death group(n=15)and survival group(n=85).All patients were underwent echocardiography examination by Philips IU-Elite and EPIQ5 color Doppler ultrasound,as well as the dynamic electrocardiogram examination by the standard 12 lead Holter performed with DMS-3004A electrocardiograph.The changes of heart rate turbulence index[TO,TS],heart rate variability index[SDNN,QTd,QTcd],and cardiac function index[LVEDD,LVEF]levels in each group were compared.The results showed that the TO,QTd,QTcd and LVEDD in the observation group were significantly higher than those in the control group,while TS,SDNN and LVEF were significantly lower than those in the control group(P<0.05).TS and SDNN in death group were significantly lower than those in survival group(P<0.05).The TO of death group was higher than that of survival group,while the QTd,QTcd,LVEF and LVEDD of death group were lower than those of survival group,but there was no significant difference(P>0.05).This study demonstrated that,HRT in patients with AMI decreased or even disappeared,HRV and LVEF decreased,LVEDD and QTd increased,and the QT interval prolonged.The echocardiography combined with dynamic electrocardiogram examination has important clinical value in the diagnosis and prognosis evaluation of patients with AMI.