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动态心电图诊断急性胸痛的价值及与危险分层的关系 被引量:5

The value of dynamic electrocardiogram characteristics and parameters in the early diagnosis of acute chest pain and their relationship with risk stratification
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摘要 目的探究动态心电图对急性胸痛早期的诊断价值及与危险分层的关系。方法选取2020年3月—2021年3月济源市第三人民医院115例疑似急性冠状动脉综合征(ACS)的急性胸痛患者,均行心电图检查和冠状动脉造影检查,以冠状动脉造影检查结果为“金标准”,将患者分为ACS组和非ACS组,分析急性胸痛ACS心电图特征,比较两组临床资料、血浆肌酸激酶同工酶(CK-MB)、肌钙蛋白(cTn)、肌红蛋白(Myo)、B型钠尿肽(BNP)水平、心电图特征、心电图参数[QT间期离散度(QTD)、胸导QTc间期、胸导QT间期],分析心电图特征、参数与血浆指标的相关性及诊断急性胸痛的价值,并采用急诊科胸痛评分评估(EDACS)加速诊断路径对患者进行危险分层(高危、低危),比较不同危险分层(高危、低危)患者的心电图特征、心电图参数,分析心电图特征、心电图参数与急性胸痛危险分层的关系。结果115例疑似ACS急性胸痛患者中,67.83%诊断为ACS急性胸痛,其中不稳定型心绞痛35例,心电图特征以ST-T缺血性改变为主,发作时改变明显或呈现伪性改善;非ST段抬高心肌梗死43例,心电图特征为肢体和胸导联ST段压低,T波低平、倒置,ST-T改变持续存在和呈动态衍变;ACS组血浆CK-MB、cTn、Myo、BNP水平、心电图特征阳性率、QTD、胸导QTc间期、胸导QT间期均高于非ACS组(P<0.05);ACS急性胸痛患者心电图特征阳性率、QTD、胸导QTc间期、胸导QT间期与血浆CKMB、cTn、Myo、BNP水平呈正相关(P<0.05);心电图特征阳性率、QTD、胸导QTc间期、胸导QT间期诊断ACS急性胸痛的曲线下面积(AUC)分别为0.526、0.823、0.826、0.875,联合诊断的AUC最大,为0.959,最佳诊断敏感度、特异度分别为83.33%、97.30%;高危患者心电图特征阳性率、QTD、胸导QTc间期、胸导QT间期均高于低危患者(P<0.05);急性胸痛患者的危险分层与心电图特征阳性率、QTD、胸导QTc间期、胸导QT间期呈正相� Objective To explore the value of dynamic electrocardiogram characteristics and parameters in the early diagnosis of acute chest pain and their relationship with risk stratification.Methods From March 2020 to March 2021,115 patients with acute chest pain suspected of Acute coronary syndrome(ACS)in Jiyuan Third People's Hospital were selected and underwent electrocardiography and coronary angiography.The patients were divided into ACS and non_x005f ACS groups,then the ECG characteristics of ACS in acute chest pain were analyzed,and the clinical data,plasma creatine kinase isoenzymes(CK-MB),cardiac troponin(cTn)and myoglobin(Myo),B-type natriuretic peptide(BNP)levels,ECG features,ECG parameters[QT dispersion(QTD),sternal QTc interval,sternal QT interval]were compared between the two groups.The correlation between ECG features,ECG parameters and plasma indicators and the value of diagnosing acute chest pain were analysed.The Emergency Department Assessment of Chest pain Score(EDACS)accelerated diagnosis pathway were used to stratify patients by risk(high risk,low risk),and the ECG characteristics and ECG parameters of patients in different risk strata(high risk,low risk)were compared.The relationship between ECG characteristics and ECG parameters and risk stratification of acute chest pain were analysed.Results Among of 115 patients with suspected ACS acute chest pain,67.83% were diagnosed with ACS acute chest pain.Among them,35 cases were unstable angina.The electrocardiogram features were mainly ST-T ischemic changes,and the changes were obvious or pseudo-improvement during the attack;43 cases of non-ST-segment elevation myocardial infarction,ECG features were ST-segment depression in limbs and chest leads,T wave low and flat,inverted,ST-T changes persisted and showed dynamic evolution;plasma CK-MB,cTn,Myo in ACS group,BNP level,ECG feature positive rate,QTD,chest lead QTc interval,chest lead QT interval were higher than non-ACS group(P<0.05);ACS patients with acute chest pain had ECG feature positive rate,QTD,che
作者 商艳秋 SHANG Yanqiu(Jiyuan Third People's Hospital,Jiyuan Henan 459000,China)
出处 《中国急救复苏与灾害医学杂志》 2023年第6期710-714,共5页 China Journal of Emergency Resuscitation and Disaster Medicine
基金 二〇一七年度河南省医学科学科技攻关计划项目(编号:2017033469)。
关键词 急性胸痛 急性冠状动脉综合征 心电图 危险分层 诊断 Acute chest pain Acute coronary syndrome Electrocardiogram Risk stratification Diagnosis
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