ECG aVR与2DE联合预测AMI左前降支病变的临床研究

发布时间：2018-03-30 02:16

本文选题：心电图aVR导联　切入点：二维超声心动图　出处：《南方医科大学》2017年硕士论文

【摘要】：1.研究背景近年来,冠心病的发病率和死亡率逐年攀升,成为威胁人类健康的主要杀手。急性心肌梗死(acute myocardial infarction,AMI)是冠心病常见严重类型之一,每年全球约有1700万人死于心血管疾病,而因急性心肌梗死所致者就占到一半。随着研究的不断深入,从体表心电图到心肌酶、肌钙蛋白检测的临床应用,再到急诊冠脉造影的开展,AMI的临床诊治取得了里程碑式的发展。研究表明,2DE心室壁运动异常、左心室功能射血分数(EF)下降以及心电图aVR导联ST段抬高都可以预测左前降支近段病变,而心电图特异性表现联合二维超声心动图评估左心室射血分数均可显著提高诊断效能。探讨特异性高,灵敏度好,诊断效能佳的检测方法对防治该类疾病以及减少冠心病相关死亡率具有重要意义。2.目的本研究通过探讨心电图(ECG)与二维超声心动图(2DE)联合检测对急性心肌梗死(AMI)左前降支(LAD)病变的预测价值。3.方法回顾分析217例AMI患者的ECG、2DE资料以及冠状动脉造影结果,根据梗死相关冠状动脉血液供应的特点,分别由ECG及2DE推测梗死相关冠状动脉(IRCA),分别计算两种手段单独与联合检测对LAD病变的诊断效能,并对其准确性做统计学分析。4.结果:4.1统计患者的一般临床资料本研究共纳入217例研究对象,其中男性111例,女性106例,平均年龄61.35±11.27岁。挑选同一类型的患者,其在年龄、性别、体重、血压、血糖、血脂、不良嗜好方面均没有显著差异(P0.05)。4.2分析心电图、超声心动图以及二者联合检测对急性心肌梗死左前降支病变部位的判断价值根据统计心电图、二维超声心动图及二者联合检测预测AMI左前降支病变的临床分析,ECG推测LAD的敏感性、特异性、准确性、阳性预测值及阴性预测值分别为 64.8%、79.5%、74.7%、60.5%以及 82.3%;2DE 分别为 74.7%、89.0%、84.3%、76.8%、87.8%。而两者联合检测对推测LAD分别为90.1%、92.5%、91.7%、85.3%、95.1%。2DE 推测 LAD 的准确性高于 ECG,两者联合检测的诊断效能优于单独检测,差异有统计学意义(P0.05)。由于心电图和二维超声心动图在诊断AMI前降支病变各有优缺点,两者结合可明显提高诊断效能。因此,在诊断AMI时同时使用心电图以及二维超声心动图两种简单、方便、对人体无损害、无创伤、无副作用的检查手段,方便临床医师了解病变对心功能的影响、判断药物的治疗效果及疾病的预后,进而为心脏介入选择合适的治疗方法,为预测IRCA提供可靠依据,值得在临床推广。
[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 卤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.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

【参考文献】