心电图与动态心电图对冠心病的诊断效能比较

Comparison between diagnostic efficiency of electrocardiogram and ambulatory electrocardiography for coronary heart disease

目的 探讨常规心电图及动态心电图对冠心病的诊断效能,分析冠心病患者心电图碎裂QRS波(fragmented QRS complex,fQRS)特征,以期为临床早期诊断、制定干预方案提供参考。方法 选取80例疑似冠心病患者作为研究对象,入院后均行心电图与动态心电图检查。以冠状动脉造影结果为金标准,统计心电图、动态心电图检查对冠心病的诊断结果、诊断效能,并比较这两种检查方式对冠心病不同类型心律失常的检出率,分析冠心病患者心电图fQRS特征。结果 心电图检查结果显示,80例受检者中心律失常阳性45例,阴性35例;动态心电图检查结果显示,心律失常阳性55例,阴性25例。动态心电图诊断冠心病的敏感性(93.10%)、准确率(93.75%)明显高于心电图(分别为74.14%、78.75%),漏诊率显著低于心电图(6.90%vs.25.76%,均P<0.05)。动态心电图检查对冠心病患者房室阻滞、房性早搏、室性早搏、成对房性早搏、成对室性早搏、短阵室上性心动过速、阵发性心房颤动的检出率明显高于心电图(均P<0.05)。冠心病患者心电图fQRS发生率显著高于无冠心病患者(P<0.05),且多发生于下壁导联。结论 动态心电图诊断冠心病的准确率显著高于心电图,可为临床早期筛查与诊断提供依据。临床上可通过动态心电图检查评估心律失常,制定相应的干预方案。

Objective To investigate the diagnostic efficiency of routine electrocardiogram(ECG) and ambulatory electrocardiography(AECG) for coronary heart disease(CHD),and to analyze the characteristics of fragmented QRS complex(fQRS) in ECG,providing references for making early clinical diagnosis and intervention program.Methods We selected 80 patients with suspected CHD as research objects.ECG and AECG examinations were both performed on them after admission.With the results of coronary angiography as “gold standard”,statistics were performed on the diagnostic results and efficiency of ECG and AECG for CHD,and the detection rates of different types of arrhythmias in CHD patients were compared between the two examination methods.The characteristics of fQRS in ECG were analyzed among CHD patients.Results The results of ECG examination showed that in the 80 examinees,there were 45 arrhythmia positive cases and 35 negative cases,while AECG examination detected 55 positive cases and 25 negative cases.Compared with ECG,the sensitivity and accuracy rate of AECG for the diagnosis of CHD were significantly higher(74.14% vs.93.10%,78.75% vs.93.75%),while the rate of missed diagnosis was significantly lower(25.76% vs.6.90%,all P<0.05).The detection rates of atrioventricular block,atrial premature beats,premature ventricular contraction,paired atrial premature beats,paired premature ventricular contraction,short paroxysmal supraventricular tachycardia and paroxysmal atrial fibrillation by AECG examination in CHD patients were significantly higher than those by ECG(all P<0.05).The incidence of ECG fQRS in CHD patients was significantly higher than that in cases without CHD(P<0.05),and most of fQRS occurred in the inferior wall lead.Conclusion The accuracy rate of AECG in the diagnosis of CHD is significantly higher than that of ECG,which provides a basis for clinical early screening and diagnosis.AECG could be used to evaluate arrhythmias clinically and formulate intervention programs correspondingly.