心肌缺血早期心電圖指標(biāo)的變化研究
發(fā)布時(shí)間：2019-06-20 06:45
【摘要】：目的:接受介入治療的冠心病(coronary heart disease,CHD)患者于冠狀動(dòng)脈球囊擴(kuò)張術(shù)(percutaneous transluminal coronary angioplasty,PTCA)時(shí)阻塞冠脈血流,會(huì)造成確切的一過(guò)性心肌缺血。本研究分析球囊擴(kuò)張引起的心電圖(electrocardiogram,ECG)各項(xiàng)指標(biāo)的變化,即分析冠心病患者心肌缺血超急性期(2min內(nèi))體表心電圖的各項(xiàng)心電指標(biāo)改變。從而探討急性冠脈閉塞性心肌缺血時(shí),除傳統(tǒng)的ST段改變之外是否存在可用于診斷早期閉塞性心肌缺血的心電圖指標(biāo)。方法:入選住院行冠狀動(dòng)脈造影確診為冠心病的患者89例,這些患者均接受罪犯血管干預(yù),行PTCA治療。術(shù)前結(jié)合患者臨床心肌缺血發(fā)作時(shí)體表標(biāo)準(zhǔn)導(dǎo)聯(lián)心電圖變化、超聲心動(dòng)圖運(yùn)動(dòng)異常及術(shù)中影像結(jié)果判斷患者心肌缺血罪犯血管。術(shù)中通過(guò)多導(dǎo)聯(lián)心電監(jiān)測(cè)系統(tǒng)監(jiān)測(cè)患者體表心電圖指標(biāo)。球囊擴(kuò)張時(shí)間為8-12S,選取球囊擴(kuò)張罪犯血管后2min內(nèi)變化明顯處的心電圖指標(biāo)與球囊擴(kuò)張前進(jìn)行比較,分析各項(xiàng)心電指標(biāo)前后有無(wú)統(tǒng)計(jì)學(xué)差異。本研究主要分析的心電指標(biāo)有QRS間期、QRS波振幅等心肌除極化指標(biāo)以及QT間期、QTc間期、Tp-Te間期、T波振幅等復(fù)極化指標(biāo),還包括PR間期及RR間期等基礎(chǔ)心電指標(biāo)。結(jié)果:1基礎(chǔ)心電指標(biāo):球囊擴(kuò)張前后PR間期差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。球囊擴(kuò)張前后RR間期差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2除極化心電指標(biāo):球囊擴(kuò)張前后QRS間期的差異具有統(tǒng)計(jì)學(xué)意義(P=0.001);球囊擴(kuò)張前后R波振幅的差異具有統(tǒng)計(jì)學(xué)意義(P=0.012)。S波振幅差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3復(fù)極化心電指標(biāo):球囊擴(kuò)張前后QTc間期的差異具有統(tǒng)計(jì)學(xué)意義(P=0.039)。T波時(shí)限、QT間期、Tp-Te間期、T波振幅的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P≥0.05)。4患者病變血管數(shù)比較:單支病變、雙支病變和三支病變患者互相比較,R波振幅和QRS間期變化的趨勢(shì)差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。5 QT間期和QTc間期的意義比較:冠狀動(dòng)脈球囊擴(kuò)張前后QT間期的變化無(wú)統(tǒng)計(jì)學(xué)意義(P=0.071),QTc間期的差異具有統(tǒng)計(jì)學(xué)意義(P=0.039)。6 ST段、R波振幅、QRS間期及QTc間期變化陽(yáng)性率的互相對(duì)比本研究采用的陽(yáng)性標(biāo)準(zhǔn):ST段抬高或壓低0.1mV為陽(yáng)性;R波振幅增高或壓低0.1mV為陽(yáng)性;QRS間期延長(zhǎng)10ms為陽(yáng)性;QTc間期延長(zhǎng)10ms為陽(yáng)性。R波振幅、QTc間期和QRS間期的陽(yáng)性率都明顯高于ST段改變的陽(yáng)性率(P值均0.05);而R波振幅、QTc間期和QRS間期的陽(yáng)性率互相比較的差異無(wú)統(tǒng)計(jì)學(xué)意義(P值均0.05)。結(jié)論:本研究通過(guò)分析冠心病患者在球囊擴(kuò)張術(shù)時(shí),即超急性期心肌缺血的心電圖,發(fā)現(xiàn)除傳統(tǒng)的ST段改變之外存在可用于判斷心肌缺血的心電指標(biāo)。急性心肌缺血的早期,除ST段抬高或者壓低之外,R波振幅、QRS間期及QTc間期均會(huì)發(fā)生較明顯的改變。我們以這三項(xiàng)指標(biāo)在心肌缺血的超急性期改變的陽(yáng)性率和傳統(tǒng)的ST段改變的陽(yáng)性率相比較,發(fā)現(xiàn)此三個(gè)指標(biāo)陽(yáng)性率均高于ST段改變的陽(yáng)性率,即R波振幅、QRS間期及QTc間期改變的敏感性高于ST段的改變。另外,本研究分析了QT間期的改變和QTc間期的改變,驗(yàn)證了QTc間期對(duì)于診斷心肌缺血的價(jià)值優(yōu)于QT間期的理論。本研究的結(jié)果提示醫(yī)務(wù)工作者在臨床工作中除ST段和T波改變之外,也需密切關(guān)注R波振幅、QRS間期及QTc間期等指標(biāo)的改變,以盡早判斷心肌缺血的發(fā)生,及時(shí)采取臨床干預(yù)治療,從而進(jìn)一步改善冠心病患者的預(yù)后。
[Abstract]:Objective: To study the effect of coronary artery balloon dilation (PTCA) on coronary heart disease (CHD) in patients with coronary heart disease (CHD). The changes of electrocardiograms (ECGs) caused by balloon dilatation were analyzed in this study, that is, the changes of the ECG parameters of the body surface electrocardiogram (ECG) in the patients with coronary heart disease (CHD) were analyzed. So as to explore the existence of an electrocardiogram index which can be used for diagnosing early occlusive myocardial ischemia, in addition to the traditional ST segment change, in the event of acute coronary occlusion myocardial ischemia. Methods:89 patients with coronary heart disease were diagnosed by coronary angiography, and the patients were treated with PTCA and PTCA. The changes of the standard lead electrocardiogram, the abnormality of the echocardiogram and the results of the intraoperative imaging were used to judge the blood vessels of the myocardial ischemia in the patients with pre-operatively combined with the clinical myocardial ischemia. The ECG of the patient's surface was monitored by the multi-lead ECG monitoring system in the operation. The time of balloon expansion was 8-12S, and the change of ECG in 2 min after balloon dilatation was compared with the pre-dilatation of the balloon, and there was no statistical difference before and after the various ECG indexes. The main results of this study are QRS interval, QRS wave amplitude and other parameters such as QT interval, QTc interval, Tp-Te interval, T wave amplitude, and other basic ECG indexes such as PR interval and RR interval. Results: The difference of PR interval before and after balloon dilatation was not statistically significant (P0.05). There was no significant difference in the RR interval before and after the balloon dilatation (P0.05). The difference of the QRS interval before and after the balloon dilatation was statistically significant (P = 0.001). The difference of R-wave amplitude before and after balloon dilatation was of statistical significance (P = 0.012). There was no significant difference in the amplitude of S-wave (P = 0.012). The difference of the QTc interval before and after balloon dilatation was of statistical significance (P = 0.039). T-wave time, QT interval, Tp-Te interval, There was no significant difference in the amplitude of T-wave (P <0.05). There was no significant difference in the changes of R-wave amplitude and QRS interval in the patients with single-branch, double-branch and three-vessel disease (P0.05). The changes of the QT interval before and after the expansion of the coronary artery were not statistically significant (P = 0.071), and the difference of the QTc interval was of statistical significance (P = 0.039). The positive criteria used in this study were the positive criteria for the positive rates of the changes in the amplitude of R-wave, the QRS interval, and the QTc interval: the ST-segment elevation or the depression of 0.1 mV was positive; The R-wave amplitude was increased or depressed by 0.1 mV positive; the QRS interval was prolonged by 10 ms to be positive; the QTc interval was prolonged by 10 ms to be positive. The positive rate of R-wave amplitude, QTc interval and QRS interval was significantly higher than that in ST segment (P <0.05), while the positive rate of R-wave amplitude, QTc interval and QRS interval was not statistically significant (P <0.05). Conclusion: In this study, the ECG of myocardial ischemia in the patients with coronary heart disease, i.e., hyperacute myocardial ischemia, was analyzed, and it was found that there were ECG indexes which could be used to judge the myocardial ischemia. In the early stage of acute myocardial ischemia, in addition to ST-segment elevation or depression, the R-wave amplitude, QRS interval and QTc interval change significantly. The positive rate of the change of the three indices in the hyperacute phase of myocardial ischemia and the positive rate of the traditional ST segment change is compared, and the positive rate of the three indexes is higher than that of the ST segment change, that is, the sensitivity of the R wave amplitude, the QRS interval and the QTc interval change is higher than that of the ST segment. In addition, the change of QT interval and the change of QTc interval were analyzed in this study, and the value of QTc interval on the diagnosis of myocardial ischemia was superior to that of the QT interval. The results of this study suggest that the medical workers need to pay close attention to the changes of R-wave amplitude, QRS interval and QTc interval in the clinical work, so as to judge the occurrence of myocardial ischemia as early as possible and to take clinical intervention in time. Thereby further improving the prognosis of patients with coronary heart disease.
【學(xué)位授予單位】：河北醫(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)】：R541.4
本文編號(hào)：2503019
[Abstract]:Objective: To study the effect of coronary artery balloon dilation (PTCA) on coronary heart disease (CHD) in patients with coronary heart disease (CHD). The changes of electrocardiograms (ECGs) caused by balloon dilatation were analyzed in this study, that is, the changes of the ECG parameters of the body surface electrocardiogram (ECG) in the patients with coronary heart disease (CHD) were analyzed. So as to explore the existence of an electrocardiogram index which can be used for diagnosing early occlusive myocardial ischemia, in addition to the traditional ST segment change, in the event of acute coronary occlusion myocardial ischemia. Methods:89 patients with coronary heart disease were diagnosed by coronary angiography, and the patients were treated with PTCA and PTCA. The changes of the standard lead electrocardiogram, the abnormality of the echocardiogram and the results of the intraoperative imaging were used to judge the blood vessels of the myocardial ischemia in the patients with pre-operatively combined with the clinical myocardial ischemia. The ECG of the patient's surface was monitored by the multi-lead ECG monitoring system in the operation. The time of balloon expansion was 8-12S, and the change of ECG in 2 min after balloon dilatation was compared with the pre-dilatation of the balloon, and there was no statistical difference before and after the various ECG indexes. The main results of this study are QRS interval, QRS wave amplitude and other parameters such as QT interval, QTc interval, Tp-Te interval, T wave amplitude, and other basic ECG indexes such as PR interval and RR interval. Results: The difference of PR interval before and after balloon dilatation was not statistically significant (P0.05). There was no significant difference in the RR interval before and after the balloon dilatation (P0.05). The difference of the QRS interval before and after the balloon dilatation was statistically significant (P = 0.001). The difference of R-wave amplitude before and after balloon dilatation was of statistical significance (P = 0.012). There was no significant difference in the amplitude of S-wave (P = 0.012). The difference of the QTc interval before and after balloon dilatation was of statistical significance (P = 0.039). T-wave time, QT interval, Tp-Te interval, There was no significant difference in the amplitude of T-wave (P <0.05). There was no significant difference in the changes of R-wave amplitude and QRS interval in the patients with single-branch, double-branch and three-vessel disease (P0.05). The changes of the QT interval before and after the expansion of the coronary artery were not statistically significant (P = 0.071), and the difference of the QTc interval was of statistical significance (P = 0.039). The positive criteria used in this study were the positive criteria for the positive rates of the changes in the amplitude of R-wave, the QRS interval, and the QTc interval: the ST-segment elevation or the depression of 0.1 mV was positive; The R-wave amplitude was increased or depressed by 0.1 mV positive; the QRS interval was prolonged by 10 ms to be positive; the QTc interval was prolonged by 10 ms to be positive. The positive rate of R-wave amplitude, QTc interval and QRS interval was significantly higher than that in ST segment (P <0.05), while the positive rate of R-wave amplitude, QTc interval and QRS interval was not statistically significant (P <0.05). Conclusion: In this study, the ECG of myocardial ischemia in the patients with coronary heart disease, i.e., hyperacute myocardial ischemia, was analyzed, and it was found that there were ECG indexes which could be used to judge the myocardial ischemia. In the early stage of acute myocardial ischemia, in addition to ST-segment elevation or depression, the R-wave amplitude, QRS interval and QTc interval change significantly. The positive rate of the change of the three indices in the hyperacute phase of myocardial ischemia and the positive rate of the traditional ST segment change is compared, and the positive rate of the three indexes is higher than that of the ST segment change, that is, the sensitivity of the R wave amplitude, the QRS interval and the QTc interval change is higher than that of the ST segment. In addition, the change of QT interval and the change of QTc interval were analyzed in this study, and the value of QTc interval on the diagnosis of myocardial ischemia was superior to that of the QT interval. The results of this study suggest that the medical workers need to pay close attention to the changes of R-wave amplitude, QRS interval and QTc interval in the clinical work, so as to judge the occurrence of myocardial ischemia as early as possible and to take clinical intervention in time. Thereby further improving the prognosis of patients with coronary heart disease.
【學(xué)位授予單位】：河北醫(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)】：R541.4
【參考文獻(xiàn)】
相關(guān)期刊論文 前1條
1 李春雨;方丕華;;運(yùn)動(dòng)試驗(yàn)檢查——ACC/AHA運(yùn)動(dòng)試驗(yàn)最新指南[J];中國(guó)醫(yī)療器械信息;2011年02期
，本文編號(hào)：2503019
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