本文選題：心電圖aVR導(dǎo)聯(lián)　切入點(diǎn)：二維超聲心動(dòng)圖　出處：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：1.研究背景近年來(lái),冠心病的發(fā)病率和死亡率逐年攀升,成為威脅人類健康的主要?dú)⑹�。急性心肌梗�?acute myocardial infarction,AMI)是冠心病常見(jiàn)嚴(yán)重類型之一,每年全球約有1700萬(wàn)人死于心血管疾病,而因急性心肌梗死所致者就占到一半。隨著研究的不斷深入,從體表心電圖到心肌酶、肌鈣蛋白檢測(cè)的臨床應(yīng)用,再到急診冠脈造影的開(kāi)展,AMI的臨床診治取得了里程碑式的發(fā)展。研究表明,2DE心室壁運(yùn)動(dòng)異常、左心室功能射血分?jǐn)?shù)(EF)下降以及心電圖aVR導(dǎo)聯(lián)ST段抬高都可以預(yù)測(cè)左前降支近段病變,而心電圖特異性表現(xiàn)聯(lián)合二維超聲心動(dòng)圖評(píng)估左心室射血分?jǐn)?shù)均可顯著提高診斷效能。探討特異性高,靈敏度好,診斷效能佳的檢測(cè)方法對(duì)防治該類疾病以及減少冠心病相關(guān)死亡率具有重要意義。2.目的本研究通過(guò)探討心電圖(ECG)與二維超聲心動(dòng)圖(2DE)聯(lián)合檢測(cè)對(duì)急性心肌梗死(AMI)左前降支(LAD)病變的預(yù)測(cè)價(jià)值。3.方法回顧分析217例AMI患者的ECG、2DE資料以及冠狀動(dòng)脈造影結(jié)果,根據(jù)梗死相關(guān)冠狀動(dòng)脈血液供應(yīng)的特點(diǎn),分別由ECG及2DE推測(cè)梗死相關(guān)冠狀動(dòng)脈(IRCA),分別計(jì)算兩種手段單獨(dú)與聯(lián)合檢測(cè)對(duì)LAD病變的診斷效能,并對(duì)其準(zhǔn)確性做統(tǒng)計(jì)學(xué)分析。4.結(jié)果:4.1統(tǒng)計(jì)患者的一般臨床資料本研究共納入217例研究對(duì)象,其中男性111例,女性106例,平均年齡61.35±11.27歲。挑選同一類型的患者,其在年齡、性別、體重、血壓、血糖、血脂、不良嗜好方面均沒(méi)有顯著差異(P0.05)。4.2分析心電圖、超聲心動(dòng)圖以及二者聯(lián)合檢測(cè)對(duì)急性心肌梗死左前降支病變部位的判斷價(jià)值根據(jù)統(tǒng)計(jì)心電圖、二維超聲心動(dòng)圖及二者聯(lián)合檢測(cè)預(yù)測(cè)AMI左前降支病變的臨床分析,ECG推測(cè)LAD的敏感性、特異性、準(zhǔn)確性、陽(yáng)性預(yù)測(cè)值及陰性預(yù)測(cè)值分別為 64.8%、79.5%、74.7%、60.5%以及 82.3%;2DE 分別為 74.7%、89.0%、84.3%、76.8%、87.8%。而兩者聯(lián)合檢測(cè)對(duì)推測(cè)LAD分別為90.1%、92.5%、91.7%、85.3%、95.1%。2DE 推測(cè) LAD 的準(zhǔn)確性高于 ECG,兩者聯(lián)合檢測(cè)的診斷效能優(yōu)于單獨(dú)檢測(cè),差異有統(tǒng)計(jì)學(xué)意義(P0.05)。由于心電圖和二維超聲心動(dòng)圖在診斷AMI前降支病變各有優(yōu)缺點(diǎn),兩者結(jié)合可明顯提高診斷效能。因此,在診斷AMI時(shí)同時(shí)使用心電圖以及二維超聲心動(dòng)圖兩種簡(jiǎn)單、方便、對(duì)人體無(wú)損害、無(wú)創(chuàng)傷、無(wú)副作用的檢查手段,方便臨床醫(yī)師了解病變對(duì)心功能的影響、判斷藥物的治療效果及疾病的預(yù)后,進(jìn)而為心臟介入選擇合適的治療方法,為預(yù)測(cè)IRCA提供可靠依據(jù),值得在臨床推廣。
[Abstract]:1. Background in recent years, the incidence and mortality of coronary heart disease (CHD) have been increasing year by year and have become the main killers threatening human health. Acute myocardial infarction (AMI) is one of the most common severe types of coronary heart disease (CHD). Every year, about 17 million people die of cardiovascular disease worldwide, and half of them are caused by acute myocardial infarction. The clinical diagnosis and treatment of AMI has made a milestone development in emergency coronary angiography. Decreased left ventricular ejection fraction (EFF) and St segment elevation in aVR lead can predict proximal left anterior descending branch lesions. The evaluation of left ventricular ejection fraction (LVEF) by electrocardiogram (ECG) and two-dimensional echocardiography can significantly improve the diagnostic efficacy. It is important to prevent and treat these diseases and reduce the mortality associated with coronary heart disease. Objective to study the combined detection of ECG and 2DE in acute myocardial infarction (AMI). The predictive value of left anterior descending branch (lad) lesions was analyzed retrospectively in 217 patients with AMI and the results of coronary angiography. According to the characteristics of blood supply of infarct-associated coronary artery, ECG and 2DE were used to estimate the diagnostic efficacy of the two methods in the diagnosis of LAD. Results A total of 217 subjects were included in the study, including 111 males and 106 females, with an average age of 61.35 鹵11.27 years. There was no significant difference in body weight, blood pressure, blood glucose, blood lipids, and bad habits. Clinical Analysis of Two-dimensional Echocardiography and combined Detection of two dimensional Echocardiography in predicting left anterior descending Branch lesions of AMI the sensitivity, specificity and accuracy of ECG in predicting LAD were analyzed. The positive predictive value and the negative predictive value were 60.5% and 82.3%, respectively. The diagnostic efficacy of the combined detection was better than that of the single test. The accuracy of the combined detection was 90.1%, 92.57% and 85.31%, respectively, and the accuracy of the combined detection was better than that of the single test, and the accuracy of the combined detection was better than that of the single test, and the positive predictive value and the negative predictive value were 60.5% and 82.3%, respectively, and the diagnostic efficacy of the combined detection was better than that of the single test, and the accuracy of the two methods was better than that of the single test, and the positive predictive value and the negative predictive value were 60.5% and 82.3%, respectively. The difference was statistically significant (P 0.05). Because of the advantages and disadvantages of electrocardiogram (ECG) and two-dimensional echocardiography in the diagnosis of anterior descending branch lesions of AMI, the combination of the two methods can improve the diagnostic efficacy. In the diagnosis of AMI, two simple and convenient methods, electrocardiogram and two-dimensional echocardiography, were used to diagnose AMI without injury, trauma and side effects, so as to facilitate clinicians to understand the effect of pathological changes on cardiac function. To judge the therapeutic effect and prognosis of the disease, and then to select the appropriate treatment for cardiac intervention, to provide reliable basis for predicting IRCA, which is worth to be popularized in clinical practice.
【學(xué)位授予單位】：南方醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R542.22

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