心肌缺血早期心电图指标的变化研究
发布时间：2019-06-20 06:45
【摘要】：目的:接受介入治疗的冠心病(coronary heart disease,CHD)患者于冠状动脉球囊扩张术(percutaneous transluminal coronary angioplasty,PTCA)时阻塞冠脉血流,会造成确切的一过性心肌缺血。本研究分析球囊扩张引起的心电图(electrocardiogram,ECG)各项指标的变化,即分析冠心病患者心肌缺血超急性期(2min内)体表心电图的各项心电指标改变。从而探讨急性冠脉闭塞性心肌缺血时,除传统的ST段改变之外是否存在可用于诊断早期闭塞性心肌缺血的心电图指标。方法:入选住院行冠状动脉造影确诊为冠心病的患者89例,这些患者均接受罪犯血管干预,行PTCA治疗。术前结合患者临床心肌缺血发作时体表标准导联心电图变化、超声心动图运动异常及术中影像结果判断患者心肌缺血罪犯血管。术中通过多导联心电监测系统监测患者体表心电图指标。球囊扩张时间为8-12S,选取球囊扩张罪犯血管后2min内变化明显处的心电图指标与球囊扩张前进行比较,分析各项心电指标前后有无统计学差异。本研究主要分析的心电指标有QRS间期、QRS波振幅等心肌除极化指标以及QT间期、QTc间期、Tp-Te间期、T波振幅等复极化指标,还包括PR间期及RR间期等基础心电指标。结果:1基础心电指标:球囊扩张前后PR间期差异无统计学意义(P0.05)。球囊扩张前后RR间期差异无统计学意义(P0.05)。2除极化心电指标:球囊扩张前后QRS间期的差异具有统计学意义(P=0.001);球囊扩张前后R波振幅的差异具有统计学意义(P=0.012)。S波振幅差异无统计学意义(P0.05)。3复极化心电指标:球囊扩张前后QTc间期的差异具有统计学意义(P=0.039)。T波时限、QT间期、Tp-Te间期、T波振幅的差异均无统计学意义(P≥0.05)。4患者病变血管数比较:单支病变、双支病变和三支病变患者互相比较,R波振幅和QRS间期变化的趋势差异均无统计学意义(P0.05)。5 QT间期和QTc间期的意义比较:冠状动脉球囊扩张前后QT间期的变化无统计学意义(P=0.071),QTc间期的差异具有统计学意义(P=0.039)。6 ST段、R波振幅、QRS间期及QTc间期变化阳性率的互相对比本研究采用的阳性标准:ST段抬高或压低0.1mV为阳性;R波振幅增高或压低0.1mV为阳性;QRS间期延长10ms为阳性;QTc间期延长10ms为阳性。R波振幅、QTc间期和QRS间期的阳性率都明显高于ST段改变的阳性率(P值均0.05);而R波振幅、QTc间期和QRS间期的阳性率互相比较的差异无统计学意义(P值均0.05)。结论:本研究通过分析冠心病患者在球囊扩张术时,即超急性期心肌缺血的心电图,发现除传统的ST段改变之外存在可用于判断心肌缺血的心电指标。急性心肌缺血的早期,除ST段抬高或者压低之外,R波振幅、QRS间期及QTc间期均会发生较明显的改变。我们以这三项指标在心肌缺血的超急性期改变的阳性率和传统的ST段改变的阳性率相比较,发现此三个指标阳性率均高于ST段改变的阳性率,即R波振幅、QRS间期及QTc间期改变的敏感性高于ST段的改变。另外,本研究分析了QT间期的改变和QTc间期的改变,验证了QTc间期对于诊断心肌缺血的价值优于QT间期的理论。本研究的结果提示医务工作者在临床工作中除ST段和T波改变之外,也需密切关注R波振幅、QRS间期及QTc间期等指标的改变,以尽早判断心肌缺血的发生,及时采取临床干预治疗,从而进一步改善冠心病患者的预后。
[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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
本文编号：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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
【参考文献】
相关期刊论文 前1条
1 李春雨;方丕华;;运动试验检查——ACC/AHA运动试验最新指南[J];中国医疗器械信息;2011年02期
，本文编号：2503019
本文链接：https://www.wllwen.com/yixuelunwen/xxg/2503019.html
最近更新
教材专著
