特勤人员T波改变特点及其鉴别诊断步骤探究.doc

特勤人员T波改变特点及其鉴别诊断步骤探究【摘 要】 目的 研究特勤人员T波改变特点及鉴别步骤,为其健康鉴定提供依据。方法 检查8 248例常规心电图,对523例T波改变进行研究。结果 ①T波改变阳性率为6.34%(523/8 248),50岁以下占95.60%(500/523)。②T波改变出现在Ⅱ、Ⅲ、aVF导联占43.02%(225/523),Ⅱ、Ⅲ、aVF及V4～V6导联占53.35%(279/523),其他导联占3.63%(19/523)。单项T波改变占72.85%(381/523),伴ST段轻度下移占27.15%(142/523)。③T波低平占89.87%(470/523),双峰或倒置占10.13%(53/523)。④T波改变判为功能性占99.24%(519/523),其中去除生理诱因T波自行恢复144例,T波正常变异14例,平板运动试验阴性195例,普萘洛尔试验阳性166例。病理性T波改变占0.76%(4/523),为运动试验阳性者。结论 特勤人员T波改变常见,多见于50岁以下者,大多数为功能性。采用“四步鉴别法”即“寻找生理诱因、识别正常变异、做好鉴别试验、综合资料定性”能较准确鉴别,可作为健康鉴定一项参考指标。 【关键词】T波改变;鉴别步骤;特勤人员 【Abstract】 Objective To study T wave change and its differential diagnosis procedure of staff for special services, provide the basis for health appraisal.Methods Routine ECG examination was performed in 8 248 staff for special services and T wave changes in 523 cases were analyzed.Results ①The positive rate of T wave change was 6.34%(523/8 248)with 95.60%(500/523)of patients under 50.②T wave changes in Ⅱ,Ⅲ and aVF leads accounted for 43.02%(225/523)and in Ⅱ,Ⅲ and aVF as well as V4~V6 leads 53.35%(279/523),other leads 3.63%(19/523).Monomial T wave change accounted for 72.85%(381/523)and 27.15%(142/523)with ST segment slightly depression.③89.87%(470/523)of cases with T wave low-flat and 10.13%(53/523)with two-humped or inversion.④Functional T wave change accounted for 99.24%(519/523).Among which, 144 cases of T wave change were self-restoring when physiological inducements were removed.14 with T wave normal variant and 195 with negative treadmill exercise tests, and 166 with positive propranolol tests. Pathological T wave changes accounted for 0.76%(4/523)with positive exercise test. Conclusion T wave changes are common in staff for special services, predominantly in people under 50 and most of them are functional. “Four steps differential method” such as “search for physiological inducements, identify normal variant, perform identification test and synthesize data and determine the nature” can differentiate accurately and be used