急性脑血管病心电图异常改变的研究分析

发布时间：2018-05-05 11:02

本文选题：急性脑血管病 + 心电图　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:通过观察急性脑血管病患者心电图改变的特点与颅内病灶的关系,探讨心电图异常改变的发病机制,为临床诊治提供有力的帮助。方法:选取2013年04月至2016年09月在神经内科住院的222例急性脑血管病患者,收集患者的心电图、心肌酶等临床资料。所有患者均经脑CT或MR检查确诊,采用常规心电图、心电监护监测心电图变化情况。根据心电图结果分为心电图正常组和心电图异常组。采用回顾性研究的方法对所有数据按照颅内病变性质、部位及心电图异常改变的类型进行分析。应用SPSS19.0软件对数据进行统计分析,数据以均数±标准差(X±S)表示,计数资料之间的差异以X~2检验,计量资料以例数表示,P0.05表示有显著的统计学差异。结果:222例患者的心电图异常检出率为62.6%(139/222);经积极的药物治疗后,23例患者死亡,199例好转或康复。心电图异常组患者年龄较正常组的大,但无统计学差异。心电图异常组的死亡率为15.1%(21/139),心电图正常组的死亡率为2.4%(2/83),两组相比,病死率有显著性差异(P0.05)。心电图异常组与心电图正常组间除LDH、AST、CK、CK-MB、cTn-I存在统计学差异(P0.05)外,其他生化指标均无统计学意义(P0.05)。心电图异常组患者存在18例低钾血症,11例高钾血症,部分患者心电图改变与血钾异常有关。病灶位于右侧大脑半球的心电图异常率73.8%(48/65),而位于左侧的为38.4%(28/73),有显著性差异(P0.05)。病灶位于右侧脑叶的心电图异常率76.3%(29/38),而位于左侧的异常率为53.6%(15/28),二者之间有显著性差异(P0.05)。病灶位于脑干、小脑组患者的心电图异常率73.4%(47/64)较脑叶组66.7%(44/66)、丘脑-基底节区组47.2%(34/72)明显增高,有显著性差异(P0.05)。心电图形态改变类型主要表现为:(1)心肌复极异常改变:多导联ST段抬高、压低,T波高尖、平坦、双向及巨大深倒(如Niagara瀑布样T波),异常Q波、U波(可与低钾血症无关)及Q-T间期显著延长等;(2)心律失常:窦性心动过速、窦性心动过缓、室性期前收缩、室性心动过速、房性期前收缩、阵发性心房颤动、室内传导阻滞、逸搏等。其中,以ST-T改变最多见。结论:急性脑血管病患者心电图异常检出率高,异常心电图组患者死亡率明显增高。在急性脑血管病患者中,心电图异常改变与颅内病灶的部位有着密切联系。心电图的变化形式多种多样,以ST-T改变最多见。急性脑血管病伴心电图改变的发病机制复杂多样。所以,及时明确颅内病变的性质、部位及范围,发现心电图的异常改变,并严密观察心电图改变与颅内病灶的关系,对进一步探讨心电图异常改变的发病机制及指导临床药物应用、改善患者预后意义重大。
[Abstract]:Objective: to explore the pathogenesis of abnormal changes of electrocardiogram (ECG) in patients with acute cerebrovascular disease (ACVD) by observing the relationship between the characteristics of electrocardiogram (ECG) and intracranial lesions in order to provide useful help for clinical diagnosis and treatment. Methods: 222 patients with acute cerebrovascular disease who were hospitalized in neurology department from April 2013 to September 2016 were selected and their electrocardiogram (ECG) and myocardial enzymes were collected. All the patients were diagnosed by CT or Mr, the changes of ECG were monitored by routine electrocardiogram (ECG) and electrocardiogram (ECG). According to the results of electrocardiogram, the patients were divided into normal group and abnormal group. All data were analyzed according to the nature of intracranial lesions, location and type of abnormal electrocardiogram (ECG). SPSS19.0 software was used to analyze the data. The data were expressed as mean 卤standard deviation X 卤S, the difference between counting data was tested by X2 test, and the measurement data was expressed by the number of cases (P 0.05), there was significant statistical difference. Results the positive rate of abnormal electrocardiogram in 222 patients was 62.6% 139 / 222, and 199 patients died after active drug therapy. The patients with abnormal electrocardiogram were older than those of the normal group, but there was no statistical difference. The mortality of abnormal electrocardiogram group was 15.1g / 139m, and that of normal ECG group was 2.4% / 83%. There was a significant difference in mortality between the two groups (P 0.05). There was no significant difference in other biochemical indexes between abnormal ECG group and normal ECG group except that there was a statistical difference in CK-MBTn-I (P0.05) between the two groups. There were 18 cases of hypokalemia and 11 cases of hyperkalemia in abnormal electrocardiogram group. The abnormal rate of ECG in the right hemisphere of the brain was 73.8% and that in the left side was 38.4% and 28 / 73, respectively, with a significant difference (P 0.05). The abnormal rate of electrocardiogram in the right lobe of the brain was 76.3% / 38%, while that in the left side was 53.6% / 28%. There was a significant difference between the two groups (P 0.05). The abnormal rate of electrocardiogram in the cerebellar group was significantly higher than that in the lobar group (66.7% / 66) and the thalamus-basal ganglia group (47.2% / 72), with a significant difference (P 0.05). The main changes of electrocardiogram were as follows: 1) abnormal changes of myocardial repolarization: multilead St segment elevation, low T wave height, flat and flat, Bidirectional and giant deep inversion (such as Niagara waterfall T wave, abnormal Q wave U wave (not associated with hypokalemia) and Q-T interval significantly prolonged et al.) arrhythmias: sinus tachycardia, sinus bradycardia, ventricular premature contraction, ventricular tachycardia, ventricular tachycardia. Atrial premature contraction, paroxysmal atrial fibrillation, ventricular block, escape beat, etc. Among them, the change of ST-T was the most common. Conclusion: the rate of abnormal ECG in patients with acute cerebrovascular disease is high, and the mortality rate of patients with abnormal electrocardiogram is higher. In patients with acute cerebrovascular disease, abnormal ECG changes are closely related to the location of intracranial lesions. The changes of electrocardiogram (ECG) were varied, and ST-T was the most common change. The pathogenesis of acute cerebrovascular disease with electrocardiogram changes is complex and diverse. Therefore, the nature, location and scope of intracranial lesions were determined in time, abnormal changes of electrocardiogram were found, and the relationship between changes of ECG and intracranial lesions was observed closely. It is of great significance to further study the pathogenesis of abnormal electrocardiogram and to guide the clinical use of drugs to improve the prognosis of patients.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3;R540.41

【相似文献】