CAJ | 학술논문

目的：研究心电监护时间对检出心律失常和心肌缺血的价值。方法回顾性研究2013年1—12月可疑或已诊断心脏病患者2593例。根据患者监护时间长短分为：24 h 组(2391例),48 h 组(49例)和72 h 组(153例)。比较三组间临床特点和动态心电监护参数差异。结果72 h 组较24 h 组患者年龄大[(55.7±18.7)岁比(52.3±18.4)岁,F =3.996,P =0.03]。三组患者的平均心率为(74.1±11.7)次/ min,平均心率在24 h 组[(74.4 ± 11.7)次/ min]和48 h 组[(73.7 ± 9.8)次/ min]均较72 h 组[(69.1±12.3)次/ min]快(F =14.987,P <0.01)。患者就诊症状中伴头晕/晕厥症状的比例差异有统计学意义[24 h、48 h 和72 h 组的比例分别为5.4%(127 / 2391),8.2%(4/49)和23.5%(36/153),X2=80.1,P <0.01]。患者就诊症状中伴心慌/心悸症状的比例差异有统计学意义[24 h、48 h 和72 h 组的发生率分别为22.1%(528 / 2391)比12.2%(6/49)比13.7%(21/153),X2=8.424,P =0.02]。大于2.0 s 的 RR 间期长间歇在时间长的监护中可以有效检出[5.6%(133 / 2391),6.1%(3/49)比15.7%(24/153),X2=24.456,P <0.01]。选择长时程监护在检出房性心动过速、心房颤动、心房扑动和室性心动过速的患者中较短时程监护更有优越性( X2=29.980,17.195,12.326,10.231；均为 P <0.01),而 ST-T 改变的检出率三组之间差异无统计学意义(X2= 4.496,1.559；均为 P >0.05)。结论医生更倾向于选择72 h 动态心电监护监测就诊症状中有头晕/晕厥的患者,选择24 h 监测就诊症状中有心慌/心悸的患者,延长心电监护时间可能在检出心律失常中更有意义,但监护时间的长短对心肌缺血的检出影响不大。
목적：연구심전감호시간대검출심률실상화심기결혈적개치。방법회고성연구2013년1—12월가의혹이진단심장병환자2593례。근거환자감호시간장단분위：24 h 조(2391례),48 h 조(49례)화72 h 조(153례)。비교삼조간림상특점화동태심전감호삼수차이。결과72 h 조교24 h 조환자년령대[(55.7±18.7)세비(52.3±18.4)세,F =3.996,P =0.03]。삼조환자적평균심솔위(74.1±11.7)차/ min,평균심솔재24 h 조[(74.4 ± 11.7)차/ min]화48 h 조[(73.7 ± 9.8)차/ min]균교72 h 조[(69.1±12.3)차/ min]쾌(F =14.987,P <0.01)。환자취진증상중반두훈/훈궐증상적비례차이유통계학의의[24 h、48 h 화72 h 조적비례분별위5.4%(127 / 2391),8.2%(4/49)화23.5%(36/153),X2=80.1,P <0.01]。환자취진증상중반심황/심계증상적비례차이유통계학의의[24 h、48 h 화72 h 조적발생솔분별위22.1%(528 / 2391)비12.2%(6/49)비13.7%(21/153),X2=8.424,P =0.02]。대우2.0 s 적 RR 간기장간헐재시간장적감호중가이유효검출[5.6%(133 / 2391),6.1%(3/49)비15.7%(24/153),X2=24.456,P <0.01]。선택장시정감호재검출방성심동과속、심방전동、심방복동화실성심동과속적환자중교단시정감호경유우월성( X2=29.980,17.195,12.326,10.231；균위 P <0.01),이 ST-T 개변적검출솔삼조지간차이무통계학의의(X2= 4.496,1.559；균위 P >0.05)。결론의생경경향우선택72 h 동태심전감호감측취진증상중유두훈/훈궐적환자,선택24 h 감측취진증상중유심황/심계적환자,연장심전감호시간가능재검출심률실상중경유의의,단감호시간적장단대심기결혈적검출영향불대。
Objective Dynamic electrocardiogram ( ECG ) monitoring is a well-established noninvasive method to monitor patients with syncope, chest pain or to diagnose arrhythmias and ischemia. The most effective duration of monitoring has not been established. The objective of this study is to investigate the significance of cardiac noninvasive monitoring duration for detecting arrhythmia and ischemia. Methods A retrospective study was performed in 2 593 patients with suspected or diagnosed heart diseases from Jan. 2013 to Dec. 2013. Clinical characteristics and dynamic ECG monitoring parameters were analyzed. Patients were divided into three groups based on their monitoring durations: group 24 h (2 391 cases, aged 2 to 97 years), group 48 h (49 cases, aged 15 to 86 years) and group 72 h (153 cases, aged 16 to 91 years). Results There was statistical difference between group 24 h and group 72 h in age [(52. 3 ±18. 4) years vs. (55. 7 ±18. 7) years, F = 3. 996, P = 0. 03]. The average heart rate was (74. 1 ± 11. 7) bpm. Average heart rates were decreased with monitoring durations increased among three groups [(74. 4 ± 11. 7) bpm vs. (73. 7 ± 9. 8) bpm vs. (69. 1 ± 12. 3) bpm, F = 14. 987, P < 0. 01] . (1) Patients with syncope syndrome performed longer monitoring among group 24 h, group 48 h and group 72 h, incidence rate 5. 4% , 8. 2% and 23. 5% respectively, particularly in men (X2 = 80. 1, P < 0. 01) . (2) Patients with palpitation were likely to undergo 24-hour monitoring in three groups (22. 1% vs. 12. 2% vs. 13. 7% , X2 =8. 424, P =0. 02). (3) Long RR intervals ( >2. 0 s) were detected more effectively in long-term monitoring among three groups (5. 6% vs. 6. 1% vs. 15. 7% , X2 =24. 456, P <0. 01). Atrial fibrillation, atrial flutter, atrial tachycardia and ventricular tachycardia could be highly detected after long-term monitoring ( X2 =29. 980, 17. 195, 12. 326, 10. 231, P <0. 01), while ST segment and T wave changes did not have difference among three groups (X2 =4. 496, 1. 559, P >0. 05). Conclusions The choice of the most effective duration of dynamic ECG monitoring often depends on clinical symptoms. To prolong the duration of ECG monitoring could effectively detect patients with arrhythmia, other than ischemia.