便携式远程心电监测技术在急性心肌梗死合并室性心律失常患者院外管理中的应用

The Application of External Cardiac Telemetry in Patient of Acute Myocardial Infarction Complicated with Ventricular Arrhythmia Discharge Management

目的探讨便携式远程心电监测技术在急性心肌梗死(AMI)合并室性心律失常(VAs)患者院外长期管理中的应用价值。方法收集首次明确诊断并经治疗顺利出院的AMI合并VAs的患者共87例。随机分为使用便携式动态心电记录仪组(SnapECG组)和对照组,随访至出院后3个月,确诊VAs患者延长随访时间。SnapECG组采用SnapECG仪器每日固定时间点检测1次心电图(检测时间120 s),同时自觉不适时立即检测(检测时间≥30 s)。对照组按规定时间点门诊随访行动态心电图、心电图检查。两组患者病情需要立即就诊。比较两组患者不同随访时间点VAs的检出率、检测VAs所需时间、心电图ST-T改变检出率及焦虑自评量表(SAS)、抑郁自评量表(SDS)评分量表。结果SnapECG组VAs检出率较对照组明显提高[(22/42)vs(13/42),P=0.046],VAs检出时间较对照组明显缩短[(16.3±1.9)d vs(41.7±6.3)d,P=0.006],两组患者无VAs生存曲线比较,差别具有统计学意义(P=0.013);心电图ST-T改变检出率比较,差别无统计学意义(P=0.190);SnapECG组SAS、SDS评分较对照组进一步改善(P_(SAS)=0.013,P_(SDS)=0.037);与对照组比较,SnapECG组确诊VAs检查费用每例降低了1349元;SnapECG仪器使用满意度高。结论便携式远程心电监测技术提高了AMI患者VAs检出率;改善了SAS、SDS评分;降低了AMI合并VAs患者的医疗费用;患者的接受度高。

Objective To explore the external cardiac telemetry in patient with acute myocardial infarction(AMI)complicated with ventricular arrhythmia(VAs)discharge management.Methods 87 patients initially diagnosed as AMI with VAs complication were randomly divided into the two groups of SnapECG group and control group and followed up for 3 months or longer for the definite VAs.In SnapECG group,ECG was detected once a day at a fixed time point(Ⅱ-lead ECG was recorded 120 s per day),and patients with any discomforts were detected immediately(≥30 s).Patients in the control group were given dynamic electrocardiogram and electrocardiogram examination during outpatient follow-up.The detection rate of VAs,the time needed to detect VAs,the detection rate of myocardial ischemia,SAS and SDS scores of the two groups were compared.Result The detection rate of VAs in SnapECG group was significantly higher and the time needed for diagnosis of VAs was shorter;the detection rate of myocardial ischemia had no significant difference compared with control group;the SAS and SDS scores were further improved in SnapECG group;and the satisfaction of SnapECG instrument was high.Conclusion The external cardiac telemetry can effectively raise detection rate of AMI complicated VAs,reduce the number of visits and medical expenses,improve SAS and SDS scores,and enhance the patients's satisfaction.