动态心电图和动态血压同步监测在缺血性脑卒中患者诊断中的临床价值

Clinical value of synchronous monitoring of dynamic electrocardiogram and ambulatory blood pressure in the diagnosis of patients with ischemic stroke

目的探讨动态心电图和动态血压同步监测在缺血性脑卒中(ischemic stroke,IS)患者诊断中的临床价值。方法选择2016年12月至2018年11月酒泉市金塔县人民医院接诊的46例IS患者进行研究,设定为IS组,并选取同期在我院进行检查的原发性高血压(高血压)患者32例,设定为无IS组(non-ischemic stroke,NIS)组。对所有患者进行动态心电图(dynamic electrocardiogram,DCG)和动态血压(ambulatory blood pressure,ABP)同步监测。比较两组患者昼夜血压变化、异常心电图比例和心率变异性相关指标,对相关参数进行Logistic多因素回归分析。结果与NIS组相比,IS组患者昼夜平均收缩压和血压昼夜节律消失比例均显著升高,日间平均舒张压显著降低,差异有统计学意义(P<0.05)。IS组DCG监测到房性期前收缩、房性心动过速、短阵心房颤动、室性期前收缩和ST段改变的比例明显高于NIS组,差异有统计学意义(P<0.05)。IS组在窦性R-R间期标准差(standard deviation of normal R-R intervals,SDNN)、窦性R-R间期差值的平方根(root mean square of the successive normal sinus R-R interval difference,rMSSD)和每5 min时段窦性R-R间期平均值标准差(standard deviation of the averaged normal sinus R-R intervals for all 5-minute segments over 24 hours,SDANN)等心率变异性指标上明显低于NIS组,差异有统计学意义(P<0.05)。Logistic多因素回归分析显示昼夜平均收缩压、血压昼夜节律消失、心房颤动与IS呈正相关,日间平均舒张压、SDNN、rMSSD、SDANN与IS呈负相关。结论血压昼夜节律消失、心律失常、心率变异与IS发生关系密切,同步监测高血压患者DCG和ABP对预诊断IS具有较高的临床价值。

Objectives To explore the diagnostic value of synchronous monitoring of dynamic electrocardiogram(DCG)and ambulatory blood pressure(ABP)in patients with ischemic stroke(IS).Methods Forty six patients with IS from December 2016 to November 2018 in Jinta County People′s Hospital were selected as IS group.Another 32 patients with hypertension who were examined in our hospital at the same period were selected as non IS(NIS)group.DCG and ABP of all the patients were synchronously monitored.Changes of blood pressure,DCG and heart rate variability(HRV)were compared between the two groups.An multi-factor Logistic regression analysis of IS was used to analyze the related parameters.Results Compared with NIS group,the mean systolic blood pressure(SBP)in day-night and the disappearance rate of the circadian rhythm of blood pressure in IS group increased significantly,while the mean diastolic blood pressure(DBP)in the daytime decreased significantly(P<0.05).The proportions of premature atrial beat,atrial tachycardia,transient atrial fibrillation,premature ventricular beat and ST segment change measured by DCG in IS group were significantly higher than those in NIS group(P<0.05).In IS group,HRV indexes such asstandard deviation of normal R-R intervals(SDNN),root mean square of the successive normal sinus R-R interval difference(rMSSD)and standard deviation of the averaged normal sinus R-R intervals for all 5-minute segments over 24 hours(SDANN)were significantly lower than those in NIS group(P<0.05).Multi-factor Logistic regression analysis of IS showed that mean SBP in the day-night,disappearance of circadian rhythm of blood pressure,atrial fibrillation posi⁃tively correlated with IS,while mean DBP in the daytime and SDNN,rMSSD,SDANN negatively correlated with IS.Conclusions The disappearance of circadian rhythm of blood pressure,arrhythmia and HRV closely relate to the occurrence of IS.Synchronized monitoring of DCG and ABP in patients with hypertension has high clinical value in the diagnosis of IS.