發(fā)布時間：2018-05-02 16:44

  本文選題：左束支傳導(dǎo)阻滯 + 冠脈病變�。� 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：目的:通過收集心電圖提示左束支傳導(dǎo)阻滯(LBBB)且除外急性心肌梗死患者的冠脈造影結(jié)果及高血壓、糖尿病、血脂異常、高尿酸血癥、吸煙史等病例數(shù)據(jù),分析左束支傳導(dǎo)阻滯患者同時存在或繼發(fā)于冠狀動脈病變的相關(guān)危險因素。從而當(dāng)發(fā)現(xiàn)左束支傳導(dǎo)阻滯的患者且尚未明顯束支阻滯的病因時,可以指導(dǎo)哪些患者更應(yīng)該行冠脈造影進一步檢查。方法:本研究回顧性統(tǒng)計2014年1月-2016年12月間我院心內(nèi)科住院患者,入組患者需心電圖檢查符合左束支傳導(dǎo)阻滯改變,并除外急性心肌梗死患者,收集冠狀動脈造影結(jié)果及病史等相關(guān)檢查。將出現(xiàn)嚴重冠脈病變(至少1支冠脈血管狹窄程度大于50%)的患者共36例分為陽性組,冠狀動脈無明顯變化者(每支冠脈血管斑塊狹窄程度小于50%)共101例分為對照組,記錄年齡、高血壓病、糖尿病、血脂異常、高尿酸血癥、吸煙史等,再將受試者的各因素進行相對危險度分析,得出相關(guān)性因素,再行多因素相關(guān)性分析,以分析LBBB的患者冠脈病變的可能危險因素。結(jié)果:1、行單因素分析,得出性別、高血壓、糖尿病、高尿酸四項無統(tǒng)計學(xué)意義,p值0.05,為非相關(guān)因素;年齡、血脂異常、吸煙史三項存在統(tǒng)計學(xué)差異,p值0.05,提示三者為左束支傳導(dǎo)阻滯合并冠脈病變的相關(guān)因素;2、行多因素相關(guān)分析后得出結(jié)論:血脂異常無統(tǒng)計學(xué)意義,p值0.05,年齡、吸煙史存在統(tǒng)計學(xué)意義,p值0.05,提示二者為影響左束支傳導(dǎo)阻滯合并冠脈病變的獨立危險因素,且年齡每增加1歲,患病的危險性增加33.7%,有吸煙的人患病的危吸性是沒有吸煙的人患病危險性的343.9%。3、計算得出疾病的初步預(yù)測公式為并求出最佳的cutoff截斷值為0.595,此時的靈敏度為0.806,特異度為0.99。結(jié)論:1、年齡、高LDL、吸煙史為左束支傳導(dǎo)阻滯合并冠脈病變的相關(guān)因素,其中年齡、吸煙史為影響患病的獨立危險因素;2、初步預(yù)測左束支傳導(dǎo)阻滯患者存在冠脈病變的公式:
[Abstract]:Objective: to collect the results of coronary angiography, hypertension, diabetes mellitus, dyslipidemia, hyperuricemia, smoking history and so on in patients with left bundle branch block (LBBB) except acute myocardial infarction (AMI). To analyze the risk factors associated with coronary artery disease in patients with left bundle branch block. When the cause of left bundle branch block is found and no obvious cause of bundle branch block is found which patients should be further examined by coronary angiography. Methods: from January 2014 to December 2016, the patients in our hospital underwent electrocardiogram (ECG) according to the changes of left bundle branch block, except for the patients with acute myocardial infarction. The results of coronary angiography and history were collected. A total of 36 patients with severe coronary artery disease (at least one coronary artery stenosis greater than 50) were divided into positive group and 101 patients with no significant change of coronary artery (less than 50 coronary artery stenosis) were divided into control group, recording age. Hypertension, diabetes, dyslipidemia, hyperuricemia, smoking history, and so on. To analyze the possible risk factors of coronary artery disease in patients with LBBB. Results the results showed that sex, hypertension, diabetes and hyperuricemia were not significantly correlated with sex, hypertension, diabetes, hyperuricemia, age and dyslipidemia. There was a statistical difference between the three factors in smoking history (P = 0.05), which suggested that the three factors were related factors of left bundle branch block with coronary artery disease. After multivariate correlation analysis, it was concluded that there was no significant difference in blood lipids (P < 0.05). There was a statistically significant P value of 0.05 in smoking history, suggesting that both of them were independent risk factors of left bundle branch block complicated with coronary artery disease, and the age increased by 1 year. The risk of disease was increased by 33.7, and the risk of smoking was 343.99.3.The optimal cutoff cut-off value was 0.595.The sensitivity was 0.806 and the specificity was 0.99. Conclusion: age, high LDL, smoking history are related factors of left bundle branch block with coronary artery disease. Age and smoking history are independent risk factors influencing the disease. The formula of predicting coronary artery disease in patients with left bundle branch block is preliminarily predicted.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R54

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