主动脉夹层动脉瘤早期心电图的改变特点及临床诊断意义

Early ECG changes of dissecting aortic aneurysms and the clinical significance

目的 探讨主动脉夹层动脉瘤早期心电图的改变特点及临床诊断意义。方法 选取2019年11月至2020年11月间西安国际医学中心医院收治的70例疑似主动脉夹层动脉瘤患者,均接受动态心电图、CT和超声心动图检查。分析患者早期心电图改变特点和不同检查方法的临床诊断意义。结果 62例患者早期心电图呈现窦性心动过缓和过速,58例患者呈现阵发性房性心动过速、伴有传导阻滞等,51例患者呈现ST-T段改变特点,46例患者呈现心房颤动,26例患者呈现左心室肥厚并伴有劳损,23例患者呈现窦性停搏,16例患者呈现心肌梗死症状,8例患者无异常。最终确诊为主动脉夹层动脉瘤的患者52例。52例患者中,Ⅰ型16例,Ⅱ型8例,Ⅲ型28例。动态心电图+超声心动图的准确度、灵敏度、特异度、阳性预测值和阴性预测值均高于单项超声心动图,动态心电图+CT检查的准确度、灵敏度和阴性预测值高于单项CT检查,差异均有统计学意义(均P<0.05)。三项联合检查和超声心动图+CT检查效能比较,差异无统计学意义(P>0.05)。结论 动态心电图联合CT检查或联合超声心动图检查,均能提高主动脉夹层动脉瘤的诊断准确率,有很高的临床诊断价值,值得推广应用。

Objective To investigate the characteristics of early electrocardiogram changes and clinical diagnostic significance of dissecting aortic aneurysms. Methods From November 2019 to November 2020, 70 patients with suspected dissecting aortic aneurysms were selected at Xi’an International Medical Center Hospital. All patients underwent electrocardiogram, computerized tomography(CT) and echocardiography. Characteristics of early electrocardiogram changes and the clinical diagnostic significance of different examination methods were analyzed. Results On early electrocardiogram, 62 patients had sinus bradycardia or tachycardia-bradycardia, 58 had paroxysmal atrial tachycardia and conduction block, 51 had changes in ST-T segment, 46 had atrial fibrillation, 26 had left ventricular hypertrophy and strain, 23 had sinus arrest, 16 had myocardial infarction and 8 did not have any abnormal situation. At last, 52 patients were diagnosed with dissecting aortic aneurysm. Among them, angiography, 16 patients were type I, 8 were type Ⅱ, and 28 were type Ⅲ. The diagnostic accuracy, sensitivity, positive predictive value, and negative predictive value were significantly higher for dynamic electrocardiogram plus echocardiography than those of echocardiography alone(all P<0.05). The diagnostic accuracy, sensitivity, and negative predictive value of electrocardiogram plus CT were significantly higher than those of the CT examination alone(all P<0.05). However, there was no significant in difference in with the efficacy between dynamic electrocardiogram plus CT and echocardiography and echocardiography plus CT scan(P>0.05). Conclusion Dynamic electrocardiogram combined with CT scan or echocardiography can improve the accuracy of diagnosis for dissecting aortic aneurysm, with high clinical diagnostic value.