48h动态心电图检测价值的探讨

Exploration on the value of 48 h ambulatory electrocardiogram

目的探讨48 h动态心电图检测的价值。方法采用智能动态心电图分析系统(杭州百慧)对患者进行48 h或72 h动态心电图检测,59例进行了48 h记录,7例进行了72 h记录(3个24 h,只比较前后24 h, 14例次),统计病例数为73例次,66例患者进入研究,其中男31例,女35例,年龄(17~86)岁。首先对66例的动态心电图进行大数据精确分析,再通过时间(t)RR间期散点图确定前后24 h可对比分析的对应时间,观察前后24 h心电散点图变化,并用散点图技术统计前后24 h心搏总数,早搏个数等指标,再根据心律失常类型进行比较分析。结果 (1)频发或偶发早搏:52例(59例次)患者,男26例、女26例,年龄(56.1±15.4)岁;有效分析时程(22.40±1.19) h。这类患者前后24 h的t-RR散点图和Lorenz-RR散点图具有自相似性,前后24 h的总心搏数,房性早搏(简称房早)个数、成对房早和房性心动过速以及室性早搏(简称室早)个数的比较没有显著性差异(P均>0.05);前后心搏数具有显著相关性(r=0.934,P=0.000)。(2)持续性心律失常:4例持续性心房颤动(简称房颤)、1例频发房性和室性并行心律,男2例,女3例,年龄(68.4±9.4)岁;有效分析时程(22.68±0.74) h。这类患者前后24 h的t-RR散点图和Lorenz-RR散点图具有自相似性,前后24 h总心搏数无显著性差异[(111 796±16 439)个vs (111 262±16 421)个,P=0.624],且前后24 h总心搏数明显相关(r=0.991,P=0.001);3例房颤患者长间歇定性诊断前后24 h一致。(3)阵发性心律失常:9例患者,阵发性房性扑动3例,阵发性房颤5例,阵发性窦房结功能纵向分离1例。男3例,女6例,年龄(71.2±12.7)岁,有效分析时程(22.67±0.74) h。这类患者前后24 h的t-RR散点图和Lorenz-RR散点图自相似性消失,前后24 h的心搏总数比较,亦没有显著性差异[(100 709±23 017)个vs (99 429±17 909)个,P=0.823],前后24 h总心搏数有相关性(r=0.695,P=0.038)。结论对于频发或偶发早搏、持续性心律失常患者行24 h动态心电图检查就能满足要求,而对阵发性心律失常患者行48 h动态心电图检测可能是必要的。

Objective To explore the value of 48 h ambulatory electrocardiogram(ECG). Methods 48 h or 72 h ambulatory ECG was detected by intelligent ambulatory ECG analysis system(Hangzhou Baihui). Fifty-nine cases were recorded for 48 h and 7 cases were recorded for 72 h(3 ×24 h, only the first 24 hours and the second 24 hours, the second 24 hours and the third 24 hours were compared, 14 times). The number of cases was 73 times. Sixty-six patients entered the study, including 31 males and 35 females, aged(17-86) years. Firstly, 66 cases of ambulatory ECG were accurately analyzed with big data, then the corresponding time that can be compared and analyzed the second 24 hours and the first 24 hours or the third 24 hours was determined through the time(t) RR interval scatter diagram, the changes of ECG scatter diagram for 48 hours were observed, and the total number of heart beats and premature beats in the first 24 hours, the second 24 hours were counted by scatter diagram technology, and then compared and analyzed according to the type of arrhythmia. Results(1) Frequent or occasional premature beats: 52 patients(59 times), 26 males and 26 females, aged(56.1±15.4) years;The effective analysis duration was(22.40±1.19) h. The t-RR and Lorenz-RR scattergrams of these patients had self similarity in the first 24 hours and the second 24 hours.There was no significant difference in the total number of heart beats,the number of atrial premature beats,paired atrial premature beats,atrial tachycardia and ventricular premature beats(all P>0.05);There was a significant correlation between the number of heart beats before and after(r=0.934,P=0.000).(2) Persistent arrhythmia:4 cases of persistent atrial fibrillation and 1 case of frequent atrial and ventricular parasystole,2 males and 3 females,aged(68.4±9.4)years;The effective analysis time course was(22.68±0.74)h.The t-RR scatter plot and Lorenz-RR scatter plot of these patients had self similarity in the first 24 hours and the second 24 hours.There was no significant difference in the total number of heart beats in the first 24 hours and the second 24 hours[(111 796±16 439)vs(111 262±16 421),P=0.624],and there was a significant correlation between the total number of heart beats in the first 24 hours and the second 24 hours(r=0.991,P=0.001);The qualitative diagnosis of long interval in three patients with atrial fibrillation was consistent in two time periods.(3) Paroxysmal arrhythmia:9 cases,3 cases of paroxysmal atrial flutter,5 cases of paroxysmal atrial fibrillation,and 1 case of paroxysmal longitudinal separation of sinus node function.There were 3 males and 6 females,aged(71.2±12.7)years.The effective analysis time course was(22.67±0.74)h.The self similarity of t-RR scatter plot and Lorenz-RR scatter plot in the first 24 hours and the second 24 hours disappeared.There was no significant difference in the total number of heart beats in the first 24 hours and the second 24 hours[(100 709±23 017)vs(99 429±17 909),P=0.823].There was a correlation between the total number of heart beats in the first 24 hours and the second 24 hours(r=0.695,P=0.038). Conclusion 24 hambulatory ECG can meet the requirements for patients with frequent or occasional premature beats and persistent arrhythmias,while 48 hambulatory ECG may be necessary for patients with paroxysmal arrhythmias.[Chinese Journal of Cardiac Pacing and Electrophysiology,2021,35(5):443-448]