心電圖檢查結(jié)合臨床特征在冠心病心絞痛診斷中的應(yīng)用價(jià)值分析
發(fā)布時(shí)間：2018-07-28 07:31
【摘要】：背景：冠狀動脈粥樣硬化性心臟病(CHD)是由于冠狀動脈功能性或器質(zhì)性病變導(dǎo)致冠狀動脈供血和心肌需求之間的不平衡所致的心肌損害,又稱缺血性心臟病。冠心病是全球流行廣泛的疾病,我國近年來冠心病發(fā)病率和死亡率有升高趨勢,且發(fā)病年齡趨于年輕化。據(jù)統(tǒng)計(jì),心血管疾病死亡率已躍居首位,而冠心病是最常見的心血管疾病之一,是嚴(yán)重危害人們身心健康的一種常見病、多發(fā)病,從而被稱作是“人類的第一殺手”。冠心病的主要臨床表現(xiàn)為心絞痛,臨床常根據(jù)患者的癥狀分為典型心絞痛和非典型心絞痛。冠心病常用的診斷方法有心電圖、心絞痛發(fā)作時(shí)心電圖、心電圖連續(xù)動態(tài)監(jiān)測、二維超聲心動圖、心臟X線檢查、心電圖負(fù)荷試驗(yàn)、及冠脈CTA、放射性核素檢查、磁共振顯像及冠狀動脈造影等多種檢查。其中最基本的診斷方法為心電圖,診斷的金指標(biāo)為“冠狀動脈造影”。但因?yàn)槭茚t(yī)院條件及技術(shù)的影響,并不是所有的醫(yī)院都能做冠狀動脈造影檢查,所以,探討心電圖ST-T改變結(jié)合患者臨床特征在冠心病中的診斷價(jià)值成為必然。目的：1.探討典型心絞痛、心電圖ST段壓低伴T波倒置、單純ST壓低及單純T波倒置對冠心病心絞痛的診斷價(jià)值。2.探討典型心絞痛患者心電圖ST段壓低/T波倒置與冠狀動脈造影的相關(guān)性。3.探討不同性別心電圖ST段壓低/T波倒置與冠狀動脈造影的相關(guān)性。旨在為基層醫(yī)療單位根據(jù)心電圖異常改變診斷冠心病心絞痛提供理論支持和循證醫(yī)學(xué)證據(jù)。方法：選擇235例擬診冠心病心絞痛的患者為研究對象,所有患者均行冠狀動脈造影檢查,檢查前均接受心電圖檢查。依據(jù)性別、是否合并有典型心絞痛癥狀、有無合并癥及性別進(jìn)行分組。然后將心電圖ST/T改變結(jié)果與其冠狀動脈造影結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析,并分析二者的相關(guān)性。結(jié)果：正常心電圖63例,心電圖ST/T改變172例,冠脈造影陰性68例,冠脈造影陽性167例。其心電圖診斷敏感性為76.6%,特異性為35.3%,兩種檢查方法比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。典型心絞痛164例,非典型心絞痛71例,典型癥狀診斷冠心病敏感性為70.1%,特異性為32.4%,兩種檢查方法比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。男性患者共計(jì)120例,正常心電圖者30例,心電圖ST/T改變者90例,冠狀動脈造影陰性34例,冠狀動脈造影陽性86例,在男性患者中心電圖診斷冠心病敏感性為80.2%,特異性為38.2%,兩種檢查方法比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)；心電圖ST-T壓低/T倒置與冠脈造影陽性相關(guān)性比較,相關(guān)系數(shù)0.192,P0.05,顯示男性患者心電圖ST-T壓低/T倒置與冠脈造影狹窄程度呈正相關(guān)。女性患者共計(jì)115例,正常心電圖者26例,心電圖ST/T改變者89例,冠狀動脈造影陰性34例,冠狀動脈造影陽性81例,在女性患者中心電圖診斷冠心病敏感性為72.8%,特異性為32.4%,兩種檢查方法比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。典型心絞痛患者中正常心電圖48例,心電圖ST/T改變116例,冠狀動脈造影陰性46例,冠狀動脈造影陽性118例,典型心絞痛患者中心電圖診斷冠心病敏感性為75.4%,特異性為41.3%,兩種檢查方法比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)；電圖陽性改變與冠脈造影陽性相關(guān)系數(shù)為0.165,P0.05,提示典型心絞痛患者心電圖異常和冠脈造影陽性呈正相關(guān)。非典型心絞痛患者中正常心電圖15例,異常心電圖56例,冠狀動脈造影陰性22例,冠狀動脈造影陽性49例,非典型心絞痛患者心電圖診斷冠心病敏感性為79.6%,特異性為22.7%,兩種檢查方法比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)；心電圖陽性改變與冠脈造影陽性相關(guān)系數(shù)為0.026,P0.05,提示提示非典型心絞痛患者心電圖異常和冠脈造影陽性無相關(guān)性。本組病例中無合并癥的患者78例,其中正常心電圖13例,心電圖ST/T改變者65例,冠脈造影陰性34例,冠脈造影陽性44例；兩種檢查方法比較差異具有顯著(P0.05)；敏感性為90.9%,特異性為69.2%。合并有高血壓的患者105例,其中正常心電圖24例,心電圖ST/T改變者81例,冠脈造影陰性24例,冠脈造影陽性81例；兩種檢查方法比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)；敏感性為81.5%,特異性為37.5%。合并有糖尿病患者40例,其中正常心電圖22例,心電圖ST/T改變者18例,冠脈造影陰性4例,冠脈造影陽性36例；兩種檢查方法比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)；敏感性為47.2%,特異性為13.6%。合并有高脂血癥患者12例,其中正常心電圖4例,心電圖ST/T改變者8例,冠脈造影陰性6例,冠脈造影陽性6例,兩種檢查方法比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)；敏感性為76.6%,特異性為16.7%。提示心電圖ST/T改變對合并高血壓、糖尿病、高脂血癥的患者診斷價(jià)值較大。結(jié)論：1、典型心絞痛患者心電圖ST-T壓低/T波倒置與冠狀動脈造影陽性結(jié)果有較好的相關(guān)性。2、男性患者中心電圖顯示ST-T壓低/T倒置對冠心病診斷意義較大,心電圖ST-T壓低/T倒置與冠脈造影狹窄陽性例數(shù)呈正相關(guān)。3、心電圖ST/T改變對合并高血壓、糖尿病、高脂血癥的患者診斷價(jià)值較大。
[Abstract]:Background: coronary atherosclerotic heart disease (CHD) is the cause of myocardial damage caused by coronary artery function or organic disease, which is caused by imbalance between coronary artery supply and myocardial demand. It is also known as ischemic heart disease. Coronary heart disease is a widespread disease in the world. In recent years, the incidence and mortality of coronary heart disease have increased in China. The mortality of the disease tends to be younger. According to statistics, the mortality of cardiovascular disease is the first one, and coronary heart disease is one of the most common cardiovascular diseases. It is a common disease which seriously endangers the physical and mental health of people. It is often called "the first killer of human". The main clinical manifestation of coronary heart disease is angina, and the clinical root is often rooted. The patients' symptoms are divided into typical angina pectoris and atypical angina. The common diagnostic methods of coronary heart disease are electrocardiogram, ECG, continuous dynamic monitoring of electrocardiogram, two-dimensional echocardiography, cardiac X - ray examination, electrocardiogram load test, coronary CTA, radionuclide examination, magnetic resonance imaging and coronary angiography The most basic diagnostic method is electrocardiogram, and the gold index of the diagnosis is "coronary arteriography". But because of the influence of hospital conditions and technology, not all hospitals can do coronary angiography, so it is necessary to explore the diagnostic value of ST-T changes combined with the characteristic of the patient in the coronary heart disease. Objective: 1. to explore the diagnostic value of typical angina pectoris, electrocardiogram ST segment depression, T wave inversion, simple ST depression and simple T wave inversion for coronary heart disease,.2. probe into the correlation.3. of ST segment depression /T wave inversion and coronary angiography in patients with typical angina pectoris to explore the ST segment depression of /T wave and coronary artery in different sex electrocardiogram The purpose of this study is to provide theoretical support and evidence-based medical evidence for the diagnosis of angina pectoris based on abnormal ECG changes in primary medical units. Methods: 235 patients with angina pectoris were selected as the subjects. All patients were examined by coronary angiography and all the patients received electrocardiogram before examination. Whether the symptoms of typical angina, complication and sex were grouped, the results of ST/T change of ECG and coronary angiography were statistically analyzed, and the correlation between the two cases was analyzed. Results: 63 cases of normal electrocardiogram, 172 cases of electrocardiogram ST/T change, 68 cases of coronary angiography negative, 167 cases of coronary angiography positive. The sensitivity of the electrogram was 76.6% and the specificity was 35.3%. There was no significant difference between the two methods of examination (P0.05). There were 164 cases of typical angina pectoris, 71 cases of atypical angina pectoris, the diagnosis of coronary heart disease was 70.1%, the specificity was 32.4%, and there was no statistical difference between two kinds of examination methods (P0.05). The total of the male patients was 120, positive. There were 30 cases of electrocardiography, 90 cases of electrocardiogram ST/T change, 34 cases of coronary angiography negative and 86 cases with positive coronary angiography. The sensitivity of coronary heart disease was 80.2%, specificity was 38.2% in male patients, and two kinds of examination methods were not statistically significant (P0.05); electrocardiogram ST-T depression /T inversion was associated with positive coronary angiography Sex comparison, the correlation coefficient 0.192, P0.05, showed that the ST-T low /T inversion in the male patients was positively correlated with the stenosis degree of coronary angiography. There were 115 cases in female patients, 26 cases of normal electrocardiogram, 89 cases of electrocardiogram change, 34 cases of coronary angiography negative, 81 cases of coronary arteriography positive, and the diagnosis of coronary heart disease in female patients center electrogram. The sensitivity was 72.8% and the specificity was 32.4%. There were significant differences between the two methods of examination (P0.05). There were 48 cases of normal electrocardiogram in patients with typical angina, 116 cases of electrocardiogram ST/T change, 46 coronary angiography negative, 118 cases with positive coronary angiography, and the diagnosis of coronary heart disease sensitivity was 75.4% and specificity of typical angina pectoris patients. There was no statistical difference between the two methods (P0.05), and the correlation coefficient of electrogram positive change and coronary angiography was 0.165, P0.05, suggesting that the abnormal electrocardiogram of the typical angina patients was positively correlated with the positive coronary angiography. 15 cases of normal electrocardiography, 56 abnormal electrocardiogram and coronary angiography Yin in atypical angina patients. In 22 cases, 49 cases were positive for coronary angiography, the sensitivity of electrocardiogram in atypical angina was 79.6% and specificity was 22.7%. There was no significant difference between two kinds of examination methods (P0.05); the correlation coefficient of electrocardiogram positive change and coronary angiography positive was 0.026, P0.05, suggesting electrocardiogram of atypical angina patients. There were no correlation with positive coronary angiography. There were 78 patients in this group, of which there were 13 cases of normal electrocardiogram, 65 cases of electrocardiogram ST/T change, 34 cases of coronary angiography negative, 44 cases with positive coronary angiography, the two examination methods were significantly different (P0.05), the sensitivity was 90.9%, and the specificity was 69.2%. combined hypertension patients. In 105 cases, there were 24 cases of normal electrocardiogram, 81 cases of electrocardiogram ST/T change, 24 cases with negative coronary angiography and 81 cases with positive coronary angiography, two examination methods had no statistically significant difference (P0.05), the sensitivity was 81.5%, the specificity was 37.5%. with 40 patients with diabetes, 22 in normal electrocardiogram, 18 cases of ST/T change in ECG, and 18 cases of coronary artery. There were 4 cases of contrast negative and 36 cases with positive coronary angiography (P0.05), the sensitivity was not statistically significant (P0.05), the sensitivity was 47.2%, and the specificity was 12 cases of 13.6%. with hyperlipidemia, including 4 normal electrocardiogram, 8 ECG ST/T changes, 6 coronary angiography negative, 6 coronary angiography positive, two examination methods of comparison difference. No statistical significance (P0.05); sensitivity of 76.6%, specificity of 16.7%. suggests that electrocardiogram ST/T changes in the combination of hypertension, diabetes, hyperlipidemia patients with greater diagnostic value. Conclusion: 1, typical angina patients with ST-T low /T wave inversion and coronary angiography positive results have a better correlation of.2, male patients center electricity The results show that ST-T depression /T inversion is of great significance for the diagnosis of coronary heart disease. The number of positive cases of /T inversion with ST-T depression and coronary angiography is positively related to.3, and the change of ST/T in ECG is of great value in the diagnosis of patients with hypertension, diabetes and hyperlipidemia.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R541.4
本文編號：2149361
[Abstract]:Background: coronary atherosclerotic heart disease (CHD) is the cause of myocardial damage caused by coronary artery function or organic disease, which is caused by imbalance between coronary artery supply and myocardial demand. It is also known as ischemic heart disease. Coronary heart disease is a widespread disease in the world. In recent years, the incidence and mortality of coronary heart disease have increased in China. The mortality of the disease tends to be younger. According to statistics, the mortality of cardiovascular disease is the first one, and coronary heart disease is one of the most common cardiovascular diseases. It is a common disease which seriously endangers the physical and mental health of people. It is often called "the first killer of human". The main clinical manifestation of coronary heart disease is angina, and the clinical root is often rooted. The patients' symptoms are divided into typical angina pectoris and atypical angina. The common diagnostic methods of coronary heart disease are electrocardiogram, ECG, continuous dynamic monitoring of electrocardiogram, two-dimensional echocardiography, cardiac X - ray examination, electrocardiogram load test, coronary CTA, radionuclide examination, magnetic resonance imaging and coronary angiography The most basic diagnostic method is electrocardiogram, and the gold index of the diagnosis is "coronary arteriography". But because of the influence of hospital conditions and technology, not all hospitals can do coronary angiography, so it is necessary to explore the diagnostic value of ST-T changes combined with the characteristic of the patient in the coronary heart disease. Objective: 1. to explore the diagnostic value of typical angina pectoris, electrocardiogram ST segment depression, T wave inversion, simple ST depression and simple T wave inversion for coronary heart disease,.2. probe into the correlation.3. of ST segment depression /T wave inversion and coronary angiography in patients with typical angina pectoris to explore the ST segment depression of /T wave and coronary artery in different sex electrocardiogram The purpose of this study is to provide theoretical support and evidence-based medical evidence for the diagnosis of angina pectoris based on abnormal ECG changes in primary medical units. Methods: 235 patients with angina pectoris were selected as the subjects. All patients were examined by coronary angiography and all the patients received electrocardiogram before examination. Whether the symptoms of typical angina, complication and sex were grouped, the results of ST/T change of ECG and coronary angiography were statistically analyzed, and the correlation between the two cases was analyzed. Results: 63 cases of normal electrocardiogram, 172 cases of electrocardiogram ST/T change, 68 cases of coronary angiography negative, 167 cases of coronary angiography positive. The sensitivity of the electrogram was 76.6% and the specificity was 35.3%. There was no significant difference between the two methods of examination (P0.05). There were 164 cases of typical angina pectoris, 71 cases of atypical angina pectoris, the diagnosis of coronary heart disease was 70.1%, the specificity was 32.4%, and there was no statistical difference between two kinds of examination methods (P0.05). The total of the male patients was 120, positive. There were 30 cases of electrocardiography, 90 cases of electrocardiogram ST/T change, 34 cases of coronary angiography negative and 86 cases with positive coronary angiography. The sensitivity of coronary heart disease was 80.2%, specificity was 38.2% in male patients, and two kinds of examination methods were not statistically significant (P0.05); electrocardiogram ST-T depression /T inversion was associated with positive coronary angiography Sex comparison, the correlation coefficient 0.192, P0.05, showed that the ST-T low /T inversion in the male patients was positively correlated with the stenosis degree of coronary angiography. There were 115 cases in female patients, 26 cases of normal electrocardiogram, 89 cases of electrocardiogram change, 34 cases of coronary angiography negative, 81 cases of coronary arteriography positive, and the diagnosis of coronary heart disease in female patients center electrogram. The sensitivity was 72.8% and the specificity was 32.4%. There were significant differences between the two methods of examination (P0.05). There were 48 cases of normal electrocardiogram in patients with typical angina, 116 cases of electrocardiogram ST/T change, 46 coronary angiography negative, 118 cases with positive coronary angiography, and the diagnosis of coronary heart disease sensitivity was 75.4% and specificity of typical angina pectoris patients. There was no statistical difference between the two methods (P0.05), and the correlation coefficient of electrogram positive change and coronary angiography was 0.165, P0.05, suggesting that the abnormal electrocardiogram of the typical angina patients was positively correlated with the positive coronary angiography. 15 cases of normal electrocardiography, 56 abnormal electrocardiogram and coronary angiography Yin in atypical angina patients. In 22 cases, 49 cases were positive for coronary angiography, the sensitivity of electrocardiogram in atypical angina was 79.6% and specificity was 22.7%. There was no significant difference between two kinds of examination methods (P0.05); the correlation coefficient of electrocardiogram positive change and coronary angiography positive was 0.026, P0.05, suggesting electrocardiogram of atypical angina patients. There were no correlation with positive coronary angiography. There were 78 patients in this group, of which there were 13 cases of normal electrocardiogram, 65 cases of electrocardiogram ST/T change, 34 cases of coronary angiography negative, 44 cases with positive coronary angiography, the two examination methods were significantly different (P0.05), the sensitivity was 90.9%, and the specificity was 69.2%. combined hypertension patients. In 105 cases, there were 24 cases of normal electrocardiogram, 81 cases of electrocardiogram ST/T change, 24 cases with negative coronary angiography and 81 cases with positive coronary angiography, two examination methods had no statistically significant difference (P0.05), the sensitivity was 81.5%, the specificity was 37.5%. with 40 patients with diabetes, 22 in normal electrocardiogram, 18 cases of ST/T change in ECG, and 18 cases of coronary artery. There were 4 cases of contrast negative and 36 cases with positive coronary angiography (P0.05), the sensitivity was not statistically significant (P0.05), the sensitivity was 47.2%, and the specificity was 12 cases of 13.6%. with hyperlipidemia, including 4 normal electrocardiogram, 8 ECG ST/T changes, 6 coronary angiography negative, 6 coronary angiography positive, two examination methods of comparison difference. No statistical significance (P0.05); sensitivity of 76.6%, specificity of 16.7%. suggests that electrocardiogram ST/T changes in the combination of hypertension, diabetes, hyperlipidemia patients with greater diagnostic value. Conclusion: 1, typical angina patients with ST-T low /T wave inversion and coronary angiography positive results have a better correlation of.2, male patients center electricity The results show that ST-T depression /T inversion is of great significance for the diagnosis of coronary heart disease. The number of positive cases of /T inversion with ST-T depression and coronary angiography is positively related to.3, and the change of ST/T in ECG is of great value in the diagnosis of patients with hypertension, diabetes and hyperlipidemia.
【學(xué)位授予單位】：新鄉(xiāng)醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R541.4
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