【作者】 樊秋艳；

【导师】 王雄；

【作者基本信息】 山西医科大学 ， 心血管内科学， 2009， 硕士

【摘要】 研究目的分析静息心电图持续性ST段压低与冠状动脉病变以及不同冠脉病变程度的关系,持续性ST段压低与心脏结构改变的关系。方法对我院心内科2007年1月到2008年9月有胸闷、胸痛等症状拟诊断为冠心病的住院患者进行回顾性分析,所有研究对象均行标准12导联静息心电图、超声心动图检查和选择性冠状动脉造影术。统计各支冠脉病变的发生情况,不同程度冠脉病变时心电图持续性ST段压低的发生情况,分析心电图对冠心病诊断的敏感性和特异性,探讨心电图对冠心病的诊断价值,以及其与冠脉病变程度的关系。统计非冠心病组中其他疾病时心电图ST段压低的发生情况,心脏结构改变与心电图改变的符合情况,以及这种符合情况与冠脉病变程度的关系,以更进一步说明心电图ST段压低对冠心病的诊断价值,为临床诊断提供依据。结果按照严格的入选标准和排除标准共选出患者430例,其中有男性患者277人,女性患者153人。其中静息心电图阳性组有179例,阴性组251例;冠脉造影阳性组212例,阴性组218例。心电图阳性组中,冠心病的发病率为37.4%,冠心病组中心电图ST段压低的发生率为31.6%。在218例冠脉造影阴性的患者中,有98例为高血压病,其中58例心电图出现ST段压低。在心电图阳性组中,有75.5%的患者出现心脏结构的改变;而在冠心病组中,心脏结构正常的患者只有11.7%出现心电图阳性改变,另外的88.3%心电图都没有出现ST段的压低。对不同冠脉病变程度组的患者进行分析,表明冠脉病变程度与持续性ST段压低及心脏结构的改变均无明显相关。结论本研究表明,冠脉造影阳性的患者中只有约三分之一的出现静息心电图持续性ST段压低,且在不同的冠脉病变组中,持续性ST段压低的比率并没有明显差别;而在静息心电图阳性组中,只有少部分为冠心病,而这部分冠心病患者还多伴有心脏结构的异常。且还发现心脏结构正常的患者中,只有极少部分出现心电图ST段压低,而心电图异常的患者中,大部分都伴有心脏结构的改变。可见,静息心电图对冠心病的诊断价值并不高,临床依据持续性ST段压低诊断冠心病时应慎重。更多还原

【Abstract】 Objective:To analyze the relationship of persistent resting ECG ST-segment depression and coronary artery disease,as well as the extent of coronary artery disease,the relation of persistent resting ECG ST-segment depression and organic heart disease.Methods:I choosed patients who were diagnosed as coronary artery disease initially for chest pain in January 2007 to September 2008 in our hospital,all patients underwent standard 12-lead resting ECG,cardiac ultrasound dynamic examination and selectively coronary angiography.To statistic on the branch of the occurrence of coronary artery disease,statistic the incidence rate of persistent ECG ST-segment depression in patients with the different extent of coronary artery disease,to analyze the sensitivity and specificity of ECG diagnosis of coronary heart disease,explore the the importance of ECG in diagnosing the coronary artery disease,as well as the relationgship between the diagnosis and the different extent of coronary artery disease.To statistic the the occurrence rate of persistent ST-segment depression in other diseases except coronary artery disease,the relationgship between the changes of cardiac structure and the persistent ECG ST-segment depression,as well as the connection between the relationship and the different extent of coronary artery disease,for further accoutting for the importance of persistent ECG ST-segment depression in diagnosin of coronary artery disease,in order to provide the value of clinical diagnosis.Results:There are 430 patients are selected with selection criteria except exclusion criteria,there are 277 men patients,the and 153 women patients.There are 179 patients who are positive on resting ECG,and the others are negative on resting ECG.There are 212 patients who are coronary heart disease,and the others are non-coronary heart disease.The incidence of coronary heart disease for 37.4%in the groups of positive resting ECG,there are 31.6 patients in 100 patients who are persistent ECG ST-segment depression in the groups of coronary heart disease.In 218 cases of patients with negative coronary angiography,98 cases of hypertension,of which 58 cases whose ECG ST segment are depressed.In ECG-positive group,75.5%of patients have cardiac structural changes,and in the group of coronary heart disease,only 11.7%of patients who have nomal cardiac structural are positive in resting ECG,and the other 88.3%of patients are negative in resting ECG.I analyse the patients who have different extent of coronary artery disease,detect that the extent of coronary artery disease with persistent ST-segment depression and cardiac changes in the structure of no significant correlation.Conclusion:The results demonstrate that only one third of patients who are coronary heart disease appear persistent resting ECG ST-segment depression,and in the groups of different coronary artery disease,there is no obvious relation between the rate of continuity ST segment depression and and the extent of coronary artery.In other group who have persistent resting ECG ST-segment depression,only a few of patients are coronary artery disease,however,these patients with coronary heart disease more associated with abnormal cardiac structure.And also found in patients with normal cardiac structure,only a few portion appear ECG ST-segment depression,the patients with ECG abnormalities,most of which accompanied by changes in the structure of the heart.So we can see,resting ECG diagnosis of coronary artery disease was not high,we should be careful if we want to take persistent ST-segment depression on resting ECG as electrocardiographic diagnostic criteria of coronary heart disease.更多还原