本文關(guān)鍵詞：房性心律失常代償間歇及聯(lián)律間期與竇房結(jié)功能相關(guān)性研究　出處：《廣州中醫(yī)藥大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 竇房結(jié)功能 竇房結(jié)功能變動時間 代償間歇 聯(lián)律間期 房性心律失常

【摘要】：目的：竇房結(jié)功能包括自律性與傳導(dǎo)性。目前評價竇房結(jié)功能的評價方面包括竇房結(jié)自律性試驗、竇房結(jié)傳導(dǎo)試驗。食管心房調(diào)搏檢查目前最具可靠性,但因其具有一定的創(chuàng)傷性,在對于食管病變及心房顫動患者存在禁忌癥,缺乏條件的醫(yī)療單位難以開展。如何從更簡便無創(chuàng)的途徑獲取支持竇房結(jié)功能測定的方法,是臨床上一重要課題。本文旨在研究房性心律失常終止后的代償間歇及聯(lián)律間期與竇房結(jié)功能的內(nèi)在聯(lián)系,探究動態(tài)心電圖對診斷竇房結(jié)功能的作用。方法：收集食管心房調(diào)搏中竇房結(jié)功能異常病例,包括功能低下及障礙情況,為排除迷走神經(jīng)作用,被檢查者均進(jìn)行阿托品試驗。對應(yīng)動態(tài)心電圖中房性心律失常終止后的代償間歇,測算竇房結(jié)功能變動時間,區(qū)分房性早搏后不同聯(lián)律間期對竇房結(jié)反應(yīng)的四種區(qū)域。計數(shù)資料采用χ2檢驗。診斷性試驗中比較兩種檢查方法(兩類計數(shù)資料)是否有本質(zhì)的不同時,采用配對卡方檢驗(McNemar檢驗)。進(jìn)行評價待評價的診斷方法(HOLTER檢查)與金標(biāo)準(zhǔn)(TEAP)檢查的一致性探究時,采用一致性檢驗(Kappa檢驗)。Kappa≥0.75兩者一致性較好；0.75Kappa≥0.4兩者一致性一般；Kappa0.4兩者一致性較差。兩獨立變量——聯(lián)律間期(X)與代償間歇(Y)關(guān)系使用相關(guān)分析(rank correlation) [58]。分析結(jié)果參考：|r|0.3,稱為微弱相關(guān),0.3≤|r|0.5,稱為低度相關(guān),0.5≤|r|0.8,稱為顯著(中度)相關(guān),0.8≤|r|1,稱為高度相關(guān)。檢驗標(biāo)準(zhǔn)為：P≤0.05為有統(tǒng)計學(xué)意義。成果：同時進(jìn)行TEAP和HOLTER檢查的總共64例患者中,在TEAP檢查里,53例檢出竇房結(jié)功能異常,11例屬于陰性結(jié)果；而HOLTER檢查里,55例通過竇房結(jié)功能變動時間0.32s的標(biāo)準(zhǔn)診斷為陽性病例,9例為陰性結(jié)果；診斷性分析表示敏感度90.57%,特異度36.36%,準(zhǔn)確度81.25%,陽性似然比1.42316,陰性似然比為0.25925,HOLTER檢查診斷竇房結(jié)功能異常的ROC曲線面積為0.693,P值為0.045,基于二項分布的McNemar檢驗,P=0.774(雙側(cè)),P0.05,兩種診斷吻合系數(shù)Kappa值為0.029,P=0.019,提示兩者一致性檢驗結(jié)果較弱,綜合各項指標(biāo)表示當(dāng)竇房結(jié)功能變動時間0.32s時,HOLTER檢查能夠輔助診斷竇房結(jié)功能異常,尤其當(dāng)竇房結(jié)功能變動時間≤320ms時,HOLTER具有排除竇房結(jié)功能異常的能力。通過三次對聯(lián)律間期(X)與代償間歇(Y)進(jìn)行相關(guān)分析后,其中Pearson分析的系數(shù)r分別為0.691,0.610,0.406,大致呈中度相關(guān),P值分別=0.000,0.000,0.001,初步得出聯(lián)律間期(X)與代償間歇(Y)兩者存在相關(guān)關(guān)系。聯(lián)律間期對代償間歇產(chǎn)生作用,進(jìn)而間接影響代償間歇的長短,再進(jìn)一步反映出竇房結(jié)功能程度。結(jié)論：HOLTER與TEAP在診斷竇房結(jié)功能異常方面具有一致性,HOLTER檢查支持輔助診斷竇房結(jié)功能異常,尤其體現(xiàn)在當(dāng)竇房結(jié)功能變動時間≤0.32s時,HOLTER具有排除竇房結(jié)功能異常的能力,可作為篩選類檢查。另外,聯(lián)律間期與代償間歇具有相關(guān)關(guān)系,聯(lián)律間期間接影響代償間歇,作用于竇房結(jié)功能變動時間的變化,從而證明HOLTER輔助診斷竇房結(jié)功能異常的能力。
[Abstract]:Objective: the function of sinoatrial node includes self-discipline and conductivity. The evaluation of sinoatrial node function at present includes the sinoatrial node self-discipline test and sinoatrial node conduction test. Esophageal atrial pacing is the most reliable method at present. However, because of its trauma, there are contraindications for patients with esophageal lesions and atrial fibrillation. It is an important clinical topic how to obtain the method to determine the function of the sinus node from a simpler and less invasive way. The purpose of this study is to investigate the relationship between compensatory interval and interatrial interval after atrial arrhythmias and the function of sinoatrial node, and to explore the role of dynamic electrocardiogram in the diagnosis of sinoatrial node function. Methods: the abnormal atrial node function in esophageal atrial pacing was collected, including functional impairment and dysfunction. Corresponding to the compensatory interval after the termination of atrial arrhythmias in the dynamic electrocardiogram, we calculated the time of functional change of sinoatrial node and distinguished the four regions of the sinoatrial node reaction after different atrial arrhythmias. The count data were tested by x 2. In the diagnostic test, the two methods (two types of counting data) were compared with the essential difference, and the paired chi square test (McNemar test) was used. The consistency test (Kappa test) was used to evaluate the consistency of the diagnostic method (HOLTER examination) and the gold standard (TEAP) examination. Kappa = 0.75, both in good agreement; 0.75Kappa = 0.4 consistency; consistency is Kappa0.4. Two independent variables, X and Y, use correlation analysis (rank correlation) [58]. The analysis results of reference: |r|0.3, known as the weak correlation, 0.3 = |r|0.5, called low correlation, 0.5 = |r|0.8, referred to as significant (moderate), 0.8 = |r|1, known as highly relevant. Test standards: P = 0.05, there was statistically significant. Results: a total of 64 cases of simultaneous TEAP and HOLTER examination in patients in the TEAP examination, 53 cases with sinus node dysfunction, 11 cases are negative results; and HOLTER examination, 55 cases with sinus node function change time of the 0.32s criteria for diagnosis of positive cases, 9 cases were negative results; diagnosis the analysis indicated the sensitivity of 90.57%, specificity of 36.36%, accuracy of 81.25%, positive likelihood ratio 1.42316, negative likelihood ratio was 0.25925, the area of ROC curve of HOLTER examination for the diagnosis of sinus node dysfunction was 0.693, P was 0.045, two distributed McNemar detection based on experience, P=0.774, P0.05 (bilateral), two diagnostic. The coefficient Kappa value is 0.029, P=0.019, suggesting that the two weak consistency test results, comprehensive indicators indicate when the sinoatrial node function change time 0.32s, HOLTER examination can diagnosis sinus node dysfunction, especially when the sinoatrial node function change time 320ms, HOLTER has the ability to eliminate abnormal sinus node function. After analyzing the correlation between the three couplets interval (X) and compensatory interval (Y), the coefficient r of Pearson analysis is 0.691,0.610,0.406, which is approximately moderately correlated, and the P value is =0.000,0.000,0.001 respectively. It is preliminarily concluded that there is a correlation between the interconnecting interval (X) and the compensatory interval (Y). The interval between compensatory intervals and the length of compensatory intermittence can be indirectly affected by interphase interval, and the function degree of sinoatrial node is further reflected. Conclusion: it has the consistency of HOLTER and TEAP in the diagnosis of sinus node dysfunction, HOLTER examination of sinus node dysfunction support diagnosis, especially when the sinoatrial node function change time is less than 0.32s, HOLTER has the ability to eliminate abnormal sinus node function, can be used as a screening test. In addition, there is a correlation between the interlative interval and compensatory interval. The interconnect interval affects the compensatory interval indirectly and acts on the change of the time function of sinoatrial node, which proves the ability of HOLTER to assist the diagnosis of sinus node dysfunction.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R541.7

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相關(guān)期刊論文 前1條

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本文編號：1346775