无症状心肌缺血中应用动态心电图诊断临床价值探讨

Clinical Value of Dynamic Electrocardiography in Diagnosis of Silent Myocardial Ischemia

目的探究动态心电图诊断在无症状心肌缺血患者中的临床价值。方法选择该院在2020年10月—2021年10月期间就诊的疑似120例无症状心肌缺血患者,均接受常规心电图诊断、动态心电图诊断,以冠状动脉CT血管造影作为金标准,分析动态心电图诊断在无症状心肌缺血患者中的使用效果。结果冠状动脉CT血管造影结果显示阳性率为77.50%,阴性率为22.50%。常规心电图诊断阳性率为59.17%,阴性率为40.83%。与冠状动脉CT血管造影相比较,常规心电图诊断的阳性率更低,阴性率更高,差异有统计学意义(χ^(2)=10.522,P=0.001)。动态心电图诊断结果显示检出阳性率为75.00%,阴性率为25.00%。与冠状动脉CT血管造影相比较,动态心电图诊断的阳性率更低,阴性率更高,但差异无统计学意义(P>0.05)。动态心电图诊断敏感度为94.62%、特异度为92.59%、准确性为94.17%、阳性预测值为97.78%、阴性预测值为83.33%。常规心电图诊断的敏感度为55.56%、特异度为63.44%、准确性为61.67%、阳性预测值为83.09%、阴性预测值为30.61%。动态心电图诊断的敏感度、特异度、准确性、阳性预测值、阴性预测值高于常规心电图诊断,差异有统计学意义(P<0.05)。结论动态心电图在无症状心肌缺血患者的诊断中效果显著,灵敏度、准确度和特异度较高,效果优于常规心电图诊断,值得在临床中进行推广使用。

Objective To explore the clinical value of dynamic electrocardiogram diagnosis in patients with asymptomatic myocar⁃dial ischemia.Methods A total of 120 patients with suspected asymptomatic myocardial ischemia who visited the hospital from October 2020 to October 2021 were selected.All received routine electrocardiogram diagnosis and dynamic electrocardiogram diagnosis.Using coronary CT angiography as the gold standard,the use of Holter monitoring in patients with asymptomatic myo⁃cardial ischemia was analyzed.Results The results of coronary CT angiography showed a positive rate of 77.50%and a negative rate of 22.50%.The positive rate of routine ECG diagnosis was 59.17%,and the negative rate was 40.83%.Compared with coronary CT angiography,the positive rate of conventional ECG diagnosis was lower and the negative rate was higher,the differ⁃ence was statistically significant(χ^(2)=10.522,P=0.001).The diagnostic results of dynamic electrocardiogram showed that the positive rate was 75.00%and the negative rate was 25.00%.Compared with coronary CT angiography,the positive rate of dy⁃namic electrocardiography was lower and the negative rate was higher,but there was no statistically significant difference(P>0.05).The diagnostic sensitivity of Holter monitoring was 94.62%,the specificity was 92.59%,the accuracy was 94.17%,the positive predictive value was 97.78%,and the negative predictive value was 83.33%.The sensitivity of routine ECG diagnosis was 55.56%,the specificity was 63.44%,the accuracy was 61.67%,the positive predictive value was 83.09%,and the negative predictive value was 30.61%.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of dynamic ECG diagnosis were higher than those of conventional ECG diagnosis,the difference was statistically significant(P<0.05).Conclusion Holter electrocardiography has a significant effect in the diagnosis of patients with asymptomatic myocardial ischemia,with high sensitivity,accuracy and specificity,and its effect is better than that of conventional electrocardiography.It is worth promoting and using in clinical practice.