动态心电图与常规心电图诊断冠心病患者无症状心肌缺血的效果比较.docVIP

动态心电图与常规心电图诊断冠心病患者无症状心肌缺血的效果比较 　　[摘要]目的 对比研究动态心电图与常规心电图诊断冠心病患者无症状心肌缺血的效果。方法 选取2013年1月～2015年12月我院收治的150例冠心病患者作为研究对象，对临床资料进行回顾性分析总结。所有患者均进行常规心电图检查、动态心电图检查，观察其对无症状性心肌缺血的检出结果。以冠状动脉造影诊断结果作为无症状性心肌缺血诊断的“金标准”，计算和比较常规心电图、动态心电图对无症状性心肌缺血的诊断敏感度、特异度、准确度，并计算常规心电图、动态心电图与冠状动脉造影诊断结果的Kappa一致性。结果 150例冠心病患者中，经冠状动脉造影共检出98例无症状性心肌缺血患者。常规心电图对无症状性心肌缺血的诊断敏感度、特异度、准确度分别为72.45%、57.69%、67.33%，动态心电图对无症状性心肌缺血的诊断敏感度、特异度、准确度分别为85.71%、76.92%、82.67%，两组相比，差异有统计学意义（P0.05）。常规心电图与冠状动脉造影诊断比较，Kappa=0.526，一致性中等；动态心电图与冠状动脉造影诊断比较，Kappa=0.719，一致性良好。结论 在无症状性心肌缺血中应用动态心电图进行诊断的准确度较之常规心电图更高，具有显著的诊断价值，可作为无症状性心肌缺血的首选诊断方法。 　　[关键词]冠心病；无症状性心肌缺血；常规心电图；动态心电图；诊断 　　[中图分类号] R541.4；R444 [文献标识码] A [文章编号] 1674-4721（2016）08（a）-0037-03 　　[Abstract]Objective To compare effect of dynamic electrocardiogram and routine electrocardiogram in diagnosis of asymptomatic myocardial ischemia in patients with coronary heart disease （CHD）.Methods 150 patients with CHD in our hospital from January 2013 to December 2015 were selected as study subjects，the clinical data were analyzed retrospectively.All patients underwent routine ECG examination and dynamic electrocardiogram examination，and the results were observed.According to coronary angiography results as gold standard diagnosis of asymptomatic myocardial ischemia，diagnostic sensitivity，specificity and accuracy of ECG，Holter monitoring electrocardiogram in symptomatic myocardial ischemia were calculated and compared，and the diagnosis of the Kappa consistency between routine ECG，dynamic electrocardiogram and coronary angiography were calculated.Results In 150 patients with CHD，98 patients with asymptomatic myocardial ischemia were detected by coronary angiography.The diagnostic sensitivity，specificity and accuracy of routine electrocardiogram in asymptomatic myocardial ischemia was 72.45%，57.69%，67.33%，with 85.71%，76.92%，82.67% of dynamic electrocardiogram respectively，the differences was statistically significant （P0.05）.Kappa in the comparison of routine ECG and coronary angiography