应用心电图及动态心电图评估心肌缺血的比较

Evaluation and analysis of different ECG modes on myocardial ischemic attack in patients with coronary heart disease

目的 探讨不同心电图模式对冠心病(CHD)心肌缺血发作的评估价值。方法 选择2020年5月至2021年5月驻马店市西平县中医院收治的80例CHD患者为研究对象,所有患者均接受冠状动脉造影,动态心电图(DCG)及常规心电图(ECG)检查,以冠状动脉造影结果为“金标准”,分析DCG、ECG对CHD心肌缺血发作的诊断价值。结果 共80例CHD患者经冠状动脉造影检查,确诊心肌缺血发作69例(86.25%),非心肌缺血发作11例(13.75%),缺血部位分别为侧壁8例(11.59%)、下壁19例(27.54%)、前间壁/前壁42例(60.87%);DCG对CHD心肌缺血发作的诊断敏感度、准确度均高于心电图,差异有统计学意义(p<0.05);DCG诊断CHD心肌缺血发作与冠脉造影检查结果一致性较好(Kappa=0.848),ECG诊断CHD心肌缺血发作与冠脉造影检查结果一致性较差(Kappa=0.237);DCG诊断的心肌缺血发作67例患者缺血部位与冠脉造影检查结果一致性较好(Kappa=0.943),准确率97.01%。结论 相较于心电图,DCG对CHD心肌缺血发作的诊断效能更高,可有效评估患者缺血部位。

Objective Toexplore the value ofdifferent ECGmodes in the evaluation ofmyocardialischemic attack of coronary heart disease(CHD). Methods Eighty patients with CHD Treated in Xiping hospital of traditional Chinese medicine from May 2020 to may 2021 were selected as the research object. All patients underwent coronary angiography,dynamic electrocardiogram(DCG) and routine electrocardiogram(ECG). Taking the results of coronary angiography as the "gold standard", the diagnostic value of DCG and ECG for myocardial ischemic attack of CHD was analyzed. Results Coronary angiography in 80 patients with CHD confirmed 69 cases of myocardial ischemic attack(86.25%), 11 cases of non myocardial ischemic attack(13.75%), 8 cases of lateral wall(11.59%), 19 cases of inferior wall(27.54%) and 42 cases of anterior septal wall/anterior wall(60.87%). The sensitivity and accuracy of DCG in the diagnosis of CHD myocardial ischemic attack were higher than ECG(p<0.05). The consistency between DCG diagnosis of CHD myocardial ischemic attack and coronary angiography was good(Kappa=0.848), and the consistency between ECG diagnosis of CHD myocardial ischemic attack and coronary angiography was poor(Kappa=0.237). The ischemic site of 67 patients with myocardial ischemic attack diagnosed by DCG was consistent with the results of coronary angiography(Kappa=0.943),and the accuracy rate was 97.01%. Conclusions Compared with ECG, DCG is more effective in the diagnosis of myocardial ischemic attack in CHD, and can effectively evaluate the ischemic site of patients.