心电图检查结合临床特征在冠心病心绞痛诊断中的应用价值分析
发布时间：2018-07-28 07:31
【摘要】：背景：冠状动脉粥样硬化性心脏病(CHD)是由于冠状动脉功能性或器质性病变导致冠状动脉供血和心肌需求之间的不平衡所致的心肌损害,又称缺血性心脏病。冠心病是全球流行广泛的疾病,我国近年来冠心病发病率和死亡率有升高趋势,且发病年龄趋于年轻化。据统计,心血管疾病死亡率已跃居首位,而冠心病是最常见的心血管疾病之一,是严重危害人们身心健康的一种常见病、多发病,从而被称作是“人类的第一杀手”。冠心病的主要临床表现为心绞痛,临床常根据患者的症状分为典型心绞痛和非典型心绞痛。冠心病常用的诊断方法有心电图、心绞痛发作时心电图、心电图连续动态监测、二维超声心动图、心脏X线检查、心电图负荷试验、及冠脉CTA、放射性核素检查、磁共振显像及冠状动脉造影等多种检查。其中最基本的诊断方法为心电图,诊断的金指标为“冠状动脉造影”。但因为受医院条件及技术的影响,并不是所有的医院都能做冠状动脉造影检查,所以,探讨心电图ST-T改变结合患者临床特征在冠心病中的诊断价值成为必然。目的：1.探讨典型心绞痛、心电图ST段压低伴T波倒置、单纯ST压低及单纯T波倒置对冠心病心绞痛的诊断价值。2.探讨典型心绞痛患者心电图ST段压低/T波倒置与冠状动脉造影的相关性。3.探讨不同性别心电图ST段压低/T波倒置与冠状动脉造影的相关性。旨在为基层医疗单位根据心电图异常改变诊断冠心病心绞痛提供理论支持和循证医学证据。方法：选择235例拟诊冠心病心绞痛的患者为研究对象,所有患者均行冠状动脉造影检查,检查前均接受心电图检查。依据性别、是否合并有典型心绞痛症状、有无合并症及性别进行分组。然后将心电图ST/T改变结果与其冠状动脉造影结果进行统计学分析,并分析二者的相关性。结果：正常心电图63例,心电图ST/T改变172例,冠脉造影阴性68例,冠脉造影阳性167例。其心电图诊断敏感性为76.6%,特异性为35.3%,两种检查方法比较差异无统计学意义(P0.05)。典型心绞痛164例,非典型心绞痛71例,典型症状诊断冠心病敏感性为70.1%,特异性为32.4%,两种检查方法比较差异无统计学意义(P0.05)。男性患者共计120例,正常心电图者30例,心电图ST/T改变者90例,冠状动脉造影阴性34例,冠状动脉造影阳性86例,在男性患者中心电图诊断冠心病敏感性为80.2%,特异性为38.2%,两种检查方法比较差异无统计学意义(P0.05)；心电图ST-T压低/T倒置与冠脉造影阳性相关性比较,相关系数0.192,P0.05,显示男性患者心电图ST-T压低/T倒置与冠脉造影狭窄程度呈正相关。女性患者共计115例,正常心电图者26例,心电图ST/T改变者89例,冠状动脉造影阴性34例,冠状动脉造影阳性81例,在女性患者中心电图诊断冠心病敏感性为72.8%,特异性为32.4%,两种检查方法比较差异有统计学意义(P0.05)。典型心绞痛患者中正常心电图48例,心电图ST/T改变116例,冠状动脉造影阴性46例,冠状动脉造影阳性118例,典型心绞痛患者中心电图诊断冠心病敏感性为75.4%,特异性为41.3%,两种检查方法比较差异无统计学意义(P0.05)；电图阳性改变与冠脉造影阳性相关系数为0.165,P0.05,提示典型心绞痛患者心电图异常和冠脉造影阳性呈正相关。非典型心绞痛患者中正常心电图15例,异常心电图56例,冠状动脉造影阴性22例,冠状动脉造影阳性49例,非典型心绞痛患者心电图诊断冠心病敏感性为79.6%,特异性为22.7%,两种检查方法比较差异无统计学意义(P0.05)；心电图阳性改变与冠脉造影阳性相关系数为0.026,P0.05,提示提示非典型心绞痛患者心电图异常和冠脉造影阳性无相关性。本组病例中无合并症的患者78例,其中正常心电图13例,心电图ST/T改变者65例,冠脉造影阴性34例,冠脉造影阳性44例；两种检查方法比较差异具有显著(P0.05)；敏感性为90.9%,特异性为69.2%。合并有高血压的患者105例,其中正常心电图24例,心电图ST/T改变者81例,冠脉造影阴性24例,冠脉造影阳性81例；两种检查方法比较差异无统计学意义(P0.05)；敏感性为81.5%,特异性为37.5%。合并有糖尿病患者40例,其中正常心电图22例,心电图ST/T改变者18例,冠脉造影阴性4例,冠脉造影阳性36例；两种检查方法比较差异无统计学意义(P0.05)；敏感性为47.2%,特异性为13.6%。合并有高脂血症患者12例,其中正常心电图4例,心电图ST/T改变者8例,冠脉造影阴性6例,冠脉造影阳性6例,两种检查方法比较差异无统计学意义(P0.05)；敏感性为76.6%,特异性为16.7%。提示心电图ST/T改变对合并高血压、糖尿病、高脂血症的患者诊断价值较大。结论：1、典型心绞痛患者心电图ST-T压低/T波倒置与冠状动脉造影阳性结果有较好的相关性。2、男性患者中心电图显示ST-T压低/T倒置对冠心病诊断意义较大,心电图ST-T压低/T倒置与冠脉造影狭窄阳性例数呈正相关。3、心电图ST/T改变对合并高血压、糖尿病、高脂血症的患者诊断价值较大。
[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.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4
本文编号：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.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4
【参考文献】
相关期刊论文 前10条
1 张凯;;冠脉造影对心电图ST-T改变的临床评价[J];海南医学;2007年07期
2 张新娅;韩雅玲;荆全民;王效增;李毅;鄢高亮;张磊;霍勇;张岩;;老年冠心病患者心血管病危险因素与冠状动脉病变程度的相关性分析[J];解放军医学杂志;2011年04期
3 俞阅彦;江时森;;生活习惯和环境因素致不同性别冠心病发病危险性的研究进展[J];医学研究生学报;2011年09期
4 刘兆军;张薇薇;刁青;;心电图正常的冠状动脉造影阳性病例分析[J];临床心电学杂志;2005年04期
5 李永生;王新萍;黄浙勇;江时森;;冠心病危险因素对症状不典型冠心病诊断的价值[J];中华老年心脑血管病杂志;2007年10期
6 孙玉波,郭文怡,贾国良;电子束CT在冠心病诊断中的应用[J];临床军医杂志;2003年01期
7 刘龙芬,陶长生,朱晓菲;不同性别心电图ST-T改变对冠心病的诊断价值[J];实用心电学杂志;2005年05期
8 郭琳;;心电图ST-T改变在冠心病诊断中的临床价值[J];中国医药指南;2010年13期
9 梁允兰;史海波;;冠心病三支病变心电图特点与冠脉造影对比研究[J];中西医结合心脑血管病杂志;2011年07期
10 刘锐;郭涛;曹晶茗;;血管内超声对冠状动脉临界病变诊疗的研究进展[J];医学综述;2012年10期
相关硕士学位论文 前1条
1 樊秋艳;心电图持续性ST段压低对冠心病的诊断价值[D];山西医科大学;2009年
，本文编号：2149361
本文链接：https://www.wllwen.com/yixuelunwen/xxg/2149361.html
最近更新
教材专著
