心电图QRS波时程比值联合实时三维超声心动图在心力衰竭患者中的应用价值

Application Value of ECG QRS Time History Ratio combined withReal-time Three-dimensional Echocardiography in Patients withHeart Failure

目的 探讨心电图QRS波时程比值(TEF)联合实时三维超声心动图在心力衰竭患者中的应用价值。方法 选择2020年8月至2021年8月鹤壁市人民医院收治并确诊为心力衰竭的200例患者作为病例组,另选择同期进行健康体检的100例健康受试者作为对照组。所有入组患者均接受彩色多普勒超声心动图仪及心电图检查。彩色多普勒超声心动图仪检测患者左心室射血分数(LVEF)、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室16节段达到最小收缩末期容积时间的标准差标准化值(Tmsv16-SD%)与最大时间差标准化值(Tmsv16-Dif%)、心电图检测左心室QRS波时限(QRSd);Person相关性分析左心室常规功能相关指标与心功能分级相关性。结果 病例组Ⅱ级、Ⅲ级和Ⅳ级患者LVEF水平明显低于对照组,而LVEDV、LVESV、Tmsv16-SD%和Tmsv16-Dif%水平明显高于对照组,且心功能级别越高上述指标变化越明显,差异有统计学意义(P <0.05)。患者LVEF随心功能不全加重明显降低,左心室QRS波时程随心功能不全加重明显增大,且随着心功能不全病情进展,LVEF与TEF逐渐降低,LVEF与NYHA心功能分级呈负相关,差异有统计学意义(r=-0.715,P <0.001),LVEDV、LVESV、TMSV16-SD%、Tmsv16-DIF%与NYHA分级呈正相关,差异有统计学意义(r=0.725、0.793、0.879、0.873,P <0.001)。结论 TEF联合三维超声心动图对心力衰竭患者心脏功能受损诊断具有较高价值,为提前制订患者救治方案、改善患者预后提供有价值医学证据。

Objecxive To explore the application value of QRS time-course ratio(TEF)combined with real-time threedimensional echocardiography in patients with heart failure.Methods A total of 200 patients diagnosed with heart failure admitted to Hebi People’s Hospital from August 2020 to August 2021 were selected as the case group.In addition,100 healthy subjects who underwent physical examination during the same period were selected as the control group.All patients were examined by color Doppler echocardiography and electrocardiogram.Left ventricular end-diastolic volume(LVEDV),left ventricular endsystolic volume(LVESV),standard deviation normalized value(Tmsv16-SD%)and maximum time difference normalized value(Tmsv16-Dif%)of the time when the left ventricular 16-segment reached the minimum end-systolic volume were detected by color Doppler echocardiography,and the time limit of QRS wave(QRSd)of left ventricle was detected by ECG;using the Person correlation analysis to analyze the correlation between left ventricular routine function related indicators and cardiac function grading.Results The level of LVEF in gradeⅡ,ⅢandⅣpatients in case group was significantly lower than that in control group,while the level of LVEDV,LVESV,Tmsv16-SD%and Tmsv16-Dif%were significantly higher than that in control group,and the higher the level of cardiac function,the more obvious the change of the above indexes was,the difference was statistically significant(P<0.05).With the aggravation of cardiac dysfunction,LVEF decreased significantly,and the duration of left ventricular QRS wave increased significantly.With the progress of cardiac dysfunction,LVEF and TEF decreased gradually.LVEF was negatively correlated with NYHA cardiac function classification,and the difference was statistically significant(r=-0.715,P<0.001).LVEDV,LVESV,TMSV16-SD%,Tmsv 16-DIF%were positively correlated with NYHA grading,and the differences were statistically significant(r=0.725,0.793,0.879,0.873,P<0.001).Conclusion The combination of TEF three-dimensional echocardiography is of high value in the diagnosis of cardiac dysfunction in patients with heart failure and provides valuable medical evidence for the early formulation of treatment plans and the improvement of patients’prognosis.