不同监测时间的动态心电图对慢性心力衰竭患者心律失常检出率的影响

Influence of Holter at Different Monitoring Time on the Detection Rate of Arrhythmia in Patients with Chronic Heart Failure

目的分析在慢性心力衰竭患者中不同监测时间动态心电图对心律失常检出率的影响。方法方便选取2018年6月—2019年6月在该院医治的400例心力衰竭患者纳入研究,按照纽约心脏协会(NYHA)心功能、N末端B型利钠肽原(NT-proBNP)以及左心室射血分数(LVEF)进行分组,观察各组患者不同时间动态心电图对室上性及室性心律失常的检出情况。结果 24 h动态心电图检出196例NSAT (64.47%),48 h检出248例NSAT (81.58%),72 h检出268例NSAT (88.16%);24 h NSVT检出率为26.00%,48 h NSVT检出率为30.50%,72 h NSVT检出率为38.00%。在NSVT检出率上,心功能3级、NT-proBNP水平≥1 000 pg/mL以及HFpEF患者72 h动态心电图明显高于24 h动态心电图,差异有统计学意义(χ2=4.320,P=0.380;χ2=3.998,P=0.046;χ2=4.148,P=0.042)。结论 48 h以及72 h动态心电图应用于慢性心力衰竭患者中对心律失常的检出率更高,24 h动态心电图能够较为容易发现心力衰竭程度较重患者的NSVT,若24 h内未有效检出,可适当延长监测时间,对临床诊治具有重要帮助。

Objective To analyze the influence of different monitoring time of Holter on the detection rate of arrhythmia in patients with chronic heart failure. Methods Convenient selection 400 patients with heart failure treated in the hospital from June 2018 to June 2019 were included in the study, according to the New York Heart Association(NYHA) heart function,N-terminal pro-B-type natriuretic peptide(NT-proBNP) and left ventricular ejection fraction(LVEF), was divided into two groups to observe the detection of supraventricular and ventricular arrhythmias by Holter at different times in each group.Results 196 cases of NSAT(64.47%) were detected in 24-hour Holter, 248 cases of NSAT(81.58%) were detected in 48 hours, and 268 cases of NSAT(88.16%) were detected in 72 hours;the detection rate of 24-hour NSVT was 26.00%, 48 hours of NSVT detection rate was 30.50%, and that of 72-hour NSVT was 38.00%. In terms of the detection rate of NSVT,patients with heart function level 3, NT-proBNP level ≥1 000 pg/mL and HFpEF patients with 72-hour Holter ECG were significantly higher than 24-hour Holter ECG, the difference was statistically significant(χ^2=4.320, P=0.38;χ^2=3.9980, P=0.046;χ^2=4.148, P=0.042). Conclusion The detection rate of arrhythmia in patients with chronic heart failure is higher in48-hour and 72-hour DYNAMIC electrocardiogram. 24-hour dynamic electrocardiogram can easily find NSVT in patients with severe heart failure. If no effective detection is made within 24 hours, the monitoring time can be appropriately extended, which is of great help to clinical diagnosis and treatment.