散点图与24 h动态心电图诊断心律失常的价值分析

目的分析心律失常患者采取散点图和24 h动态心电图进行诊断的临床价值。方法选择2020年8月—2022年8月黑龙江省第二医院收治的心律失常90例患者作为研究组,选择同期到黑龙江省第二医院进行健康体检人员90例作为对照组。两组均给予24 h动态心电图进行诊断,且通过散点图形式绘制检查的结果,对比分析24 h动态心电图、散点图的诊断情况。结果经研究组包括心率减速力(deceleration capacity of rate,DC)、24 h内每5分钟节段窦性R-R周期平均值的标准差(standard deviation of the mean of sinus R-R cycles every 5min over 24 h,SDANN)、相邻正常心动周期差值的均方根(root mean square of adjacent normal cardiac cycle differences,rMSSD)、24 h窦性心搏间期标准差(24-hour standard deviation between sinus beats,SDNN)均低于对照组,差异有统计学意义(P<0.05)。研究组散点图的形态复杂状、彗星状和扇形状比例高于对照组,差异有统计学意义(P<0.05)。研究组散点图为彗星状、鱼雷状、复杂状患者心率变异性(heart rate variability,HRV)正常范围为92.31%、70.00%、67.50%。研究组患者疾病诊断的准确性为97.78%,高于对照组的3.33%,差异有统计学意义(P<0.05)。结论心律失常患者采取散点图和24 h动态心电图进行诊断的临床价值较高,散点图可作为有效的参考依据,可提升患者疾病诊断的准确性,临床上值得推广使用。

24小时长程心电图1000例分析

分析1000例长程心电图,检出心律失常共1624例次,其中室速44例(4.4％),在相同时间内,检查住院患者的常规心电图共18198例,检出室速仅17例(0.093％)。对原因不明的昏倒或晕厥患者,大多能获得明确答案。分析结果表明,该项检查明显优于常规心电图。文中提出了须与变异“伪象”相鉴别。探讨其发生原因有:①电极位置的影响;②体位变动的影响。并建议监测导联改用CM_6较好。

参松养心胶囊治疗缓慢性心律失常伴期前收缩疗效观察

[目的]观察参松养心胶囊治疗缓慢性心律失常伴期前收缩的临床疗效。[方法]60例缓慢性心律失常伴期前收缩患者随机分为两组。治疗组30例,参松养心胶囊4粒tid;对照组30例,复方丹参片3片tid,两组均治疗4周,服药前及4周后行24h动态心电图检查、观察临床症状改善情况及不良反应。[结果]治疗组临床症状改善及心电图改善均优于对照组(P<0.05)。[结论]参松养心胶囊是治疗缓慢性心律失常伴期前收缩的有效药物。

Medium to long term prognoses in children with premature ventricular contractions: Follow-up analysis of 106 cases

Background Premature ventricular contractions （PVCs） are frequently seen in children. However, there are less systematic and longer following-up studies examining the prognosis of PVCs in children. The aim of this study was to evaluate the medium to long term prognosis of PVCs in childhood and whether there is a differential prognosis in different primary diseases of PVCs. Methods This study reviewed the data of 106 pediatric patients （49F/57M, 7.5 _ 3.8 years） seen at the Affiliated Hospital of Qingdao University with the diagnosis of PVCs between 1999 and 2005. Data on demographics, clinical presentation, laboratory tests, and echocardiograms of patients were extracted from the available clinical records. Results A total of 35 （33.0%） children presented with PVCs due to myocarditis, 7（6.6%） due to cardiomyopathies, 7（6.6%） due to mitral valve prolapse （MVP）, 10（9.4%） due to operation for congenital heart disease （O-CHD）, 16（15.2%） due to left ventricular false tendons （LVFT）, and 31（29.2%） due to unknown cause. Holter did not show PVCs during follow-up period in 100% of myocarditis patients, 57% of cardiomyopathy patients, 71% of MVP patients, 60% of O-CHD patients, 88% of LVFT patients, 87% of unknown cause patients. The PVCs disappeared in 93% of patients who did not use anti-arrhythmic drugs and in 76% of patients who used anti- arrhythmic drugs. There was no a significant difference in prognosis between myocardial nutrition combined with intravenous injection of immunoglobulin （IVIG） group and propafenone group. Conclusions PVCs caused by different primary diseases has a favorable prognosis in children. Usually, the PVCs will reduce even disappear during follow-up. The patients with PVCs due to myocarditis should be preferred use myocardial nutrient combined with IVIG.

多种无创检查组合在冠心病诊断中的价值

目的:评价多种无创辅助检查组合对冠状动脉粥样硬化性心脏病(冠心病)辅助诊断价值,筛选有效的冠心病确诊和排除指标,初步确定优化的冠心病早期诊断策略。方法:回顾性分析6419例冠心病患者多项无创辅助检查结果(包括静息心电图、24小时动态心电图、负荷心电图、负荷核素心肌显像、16或64排CT冠状动脉成像),以冠状动脉造影阳性(至少一支主要冠状动脉或其主要分支的内径有≥50%的狭窄)为金标准,观察各种无创辅助检查组合对冠心病诊断的特异性、敏感性、误诊率、漏诊率、阳性预测值和阴性预测值。结果:多项无创辅助检查组合在冠心病的诊断中敏感性56.02-87.43%,特异36.13-87.61%,阳性预测值58.83-97.16%,阴性预测值30.21-73.36%,非介入手段中,敏感性和阴性预测值以动态心电图联合核素心肌灌注显像组最高,特异性和阳性预测值以动态心电图联合冠脉CT成像组最高。结论:辅助检查组合可作为无创性诊断、评价冠心病的重要方法,动态心电图可作为各级别医院冠心病筛查的基本及重要手段。