应用动态心电图推导呼吸曲线人工分析的方法初筛睡眠呼吸暂停低通气综合征

目的:以多导睡眠分析仪作对照,探讨应用动态心电图推导呼吸曲线(EDR),采用人工分析的方法初筛睡眠呼吸暂停低通气综合征(SAHS)的可行性。方法:2004年4月～2005年10月对120例就诊于睡眠中心的患者进行整夜(>7h)多导睡眠分析仪监测,同时同步进行动态心电图检查。双方在互相不沟通的情况下分别计算睡眠呼吸暂停低通气指数(AHI),并做出SAHS阳性与阴性的诊断,以多导睡眠分析仪结果作为金标准评价应用EDR技术初筛SAHS的可行性。结果:120例患者通过多导睡眠分析仪监测,结果88例患者SAHS阳性,32例患者SAHS阴性,应用动态心电图EDR技术人工分析方法初筛SAHS结果敏感性85.2%、特异性93.8%、阳性预测值97.4%、阴性预测值69.8%、诊断符合率87.5%。受试者工作特性曲线(ROC)下面积0.938,经相关分析两者AHI的相关系数为0.879(P=0.000),两者最长睡眠呼吸暂停时间的相关系数为0.716(P=0.000),两者最长睡眠低通气时间的相关系数为0.281(P=0.005)。结论:应用动态心电图EDR技术,采用人工分析方法对可疑SAHS患者进行初筛的符合率较高,可以作为临床上SAHS诊断的辅助工具。     

动态心电图筛选睡眠呼吸暂停综合征的初步研究

目的　探讨动态心电图 (Holter)对阻塞性睡眠呼吸暂停综合征 (OSAS)患者的评价功能。方法　北京大学人民医院用多导睡眠分析仪 (PSG)对 2 0 0 3- 0 7～ 2 0 0 4 - 0 195例研究对象进行整夜睡眠监测 ,同步进行Holter检查。双方在互相不沟通的情况下各自作出阻塞性睡眠呼吸暂停综合征阳性 (OSAS )与阴性 (OSAS - )的诊断。结果　心率变异性 (HRV)频域分析指标较时域分析指标敏感 ;动态心电图以睡眠窒息危险分析评分大于 4为阳性诊断标准时 ,诊断OSAS的敏感性为 81 2 5 % ,特异性为 4 6 81% ,诊断符合率 6 4 2 1%。当分别以睡眠窒息危险分析评分大于 5、6和 7为阳性标准时 ,Holter对OSAS诊断的特异性升高 ,但敏感性、诊断符合率均降低。结论　Holter作为一种简单快捷的辅助工具筛选OSAS有一定的临床应用价值。     

智能动态血氧仪诊断睡眠呼吸暂停低通气综合征与多导睡眠图监测的一致性研究

目的：睡眠呼吸暂停低通气综合征(sleep apnea hypopnea syndrome,SAHS)是临床最常见的睡眠疾病之一,多导睡眠图监测为诊断的金标准。本研究将一种可无线传输数据至云平台并自动分析数据的腕表式智能动态脉搏血氧仪(简称“腕式血氧仪”)作为研究对象,与标准的多导睡眠图(polysomnography,PSG)监测做一致性分析,探讨腕式血氧仪对 SAHS诊断的可靠性。方法受试者为2015年6月至2016年2月就诊于首都医科大学附属北京朝阳医院呼吸科睡眠中心的疑似SAHS患者,所有受试者同时完成整夜 PSG监测和腕式血氧仪监测,分别比较 PSG和腕式血氧仪计算的氧减指数(oxygen desatuation index, ODI)、最低血氧饱和度(lowest percutaneous oxygen saturation,LSpO2)、<90%的血氧饱和度时间比率(the percentage of time spent at SpO2 below 90%, TS90%)和经皮平均血氧饱和度(mean percutaneous oxygen saturation,MSpO2)。并将 PSG 监测的呼吸暂停低通气指数(apnea hypopnea index,AHI)与腕式血氧仪监测的 ODI做一致性分析。用受试者工作特征(ROC)曲线评定 ODI诊断价值及判定诊断SAHS的界值。结果本研究共纳入201例受试者,PSG与腕式血氧仪监测的 ODI、TS90%、LSpO2之间差异无统计学意义;腕式血氧仪 ODI 与PSG监测的 AHI具有良好的相关性;ROC 曲线评价腕式脉搏血氧 ODI>10.4次/h 对 SAHS 的诊断价值敏感性及特异性均较高。结论 SAHS动态血氧波形有比较明显的特征,腕式血氧仪测得的 ODI可反应睡眠呼吸暂停的情况,可作为 SAHS的初筛设备。     

动态心电图初筛阻塞性睡眠呼吸暂停综合征

目的探讨应用动态心电图(Holter monitoring,Holter)初筛阻塞性睡眠呼吸暂停综合征(Obstructive Sleep Apnea Syndrome,OSAS)的临床价值。方法对60例患者进行整夜(>7h)多导睡眠仪(Polysomnogram,PSG)及24h动态心电图检测。根据PSG及动态心电图的结果,分别做出OSAS阳性与阴性的诊断。以PSG为金标准,分析评价应用动态心电图初筛OSAS的临床价值。结果 60例患者根据PSG检查结果分为OSAS阳性组44例,OSAS阴性组16例。动态心电图筛查出40例OSAS(真阳性38例,假阳性2例),20例除外OSAS(真阴性14例,假阴性6例)。动态心电图筛查OSAS的灵敏度86.4%,特异度87.5%,误诊率12.5%,漏诊率13.6%,阳性预测价值95%,阴性预测价值70%,总的符合率86.7%,Youden指数73.9%。结论用动态心电图初筛OSAS具有可行性,有望作为临床上诊断OSAS的辅助方法。     

动态血氧饱和度监测在睡眠呼吸暂停低通气综合征诊断中的应用

目的探讨夜间动态血氧饱和度监测对睡眠呼吸暂停低通气综合征(SAHS)的诊断价值。方法对120例疑似SAHS患者进行夜间动态血氧饱和度与多导睡眠图(PSG)监测,根据睡眠呼吸暂停低通气指数(AH I)将测试者分为SAHS组及非SAHS组。非SAHS组(AH I<5次/小时)27例,设为对照组;SAHS组又分为轻度组(AH I 5~20次/小时)26例;中度组(AH I 21~40次/小时)21例;重度组(AH I>40次/小时)46例。对监测结果进行轶和检验和Pearson相关分析,并观察不同的氧减饱和指数(O ID4)值作为诊断SAHS标准的敏感性与特异性。结果夜间动态血氧饱和度监测的O ID4与AH I的相关性良好(r=0.817,P<0.01),它能较好地反映SAHS患者睡眠时呼吸紊乱的频度。以O ID4≥5次/小时诊断SAHS,敏感性为92.4%,对SAHS具有初筛价值,但特异性只有77.8%。若以O ID4≥15次/小时诊断SAHS,特异性可达96.3%,可作为准确诊断SAHS的标准。结论选用适当的O ID4值作为SAHS的初步筛选或准确判断的标准,夜间动态血氧饱和度监测在SAHS的诊断中具有相当的临床价值。     

应用动态心电图初筛睡眠呼吸暂停低通气综合征

睡眠呼吸暂停低通气综合征(sleep apnea hypopnea syndrome,SAHS)主要表现为在睡眠中频繁的呼吸暂停、低通气.SAHS可以导致多个重要器官的功能障碍乃至衰竭,严重影响生活质量,甚至引起患者死亡,被认为是冠心病、高血压、脑血管疾病以及糖尿病的独立危险因素.诊断SAHS金标准为多导睡眠仪(polysomnogram,PSG),它需要在配备昂贵医疗设备的睡眠监测室,行7 h以上的睡眠监测后才能作出诊断,PSG费用昂贵且资源有限,本文综述应用动态心电图初筛睡眠呼吸暂停低通气综合征的可行性.     

应用动态心电图初筛睡眠呼吸暂停低通气综合征

睡眠呼吸暂停低通气综合征(sleep apnea hypopnea syndrome,SAHS)主要表现为在睡眠中频繁的呼吸暂停、低通气。SAHS可以导致多个重要器官的功能障碍乃至衰竭,严重影响生活质量,甚至引起患者死亡,被认为是冠心病、高血压、脑血管疾病以及糖尿病的独立危险因素。诊断SAHS金标准为多导睡眠仪(polysomnogram,PSG),它需要在配备昂贵医疗设备的睡眠监测室,行7h以上的睡眠监测后才能作出诊断,PSG费用昂贵且资源有限,本文综述应用动态心电图初筛睡眠呼吸暂停低通气综合征的可行性。     

睡眠呼吸暂停低通气综合征患者窦性心率震荡的变化

目的:了解睡眠呼吸暂停低通气综合征(SAHS)患者窦性心率震荡的变化。方法:对75例患者进行整夜(>7 h)多导睡眠仪监测,同时同步进行24 h动态心电图检查。根据多导睡眠仪监测结果得出睡眠呼吸暂停低通气指数(AHI),分别作出有无SAHS的诊断,将研究对象分为SAHS组(AHI≥5,n=52)与对照组(AHI<5,n=23),比较两组患者窦性心率震荡参数—震荡初始值(TO)、震荡斜率值(TS)的变化。结果:SAHS组较对照组震荡斜率值明显下降,差异有统计学意义(P<0.01)。两组震荡初始均值均<0,SAHS组>对照组,但差异无统计学意义,SAHS组24 h室性早搏的数量高于对照组,但差异无统计学意义。结论:SAHS组与对照组相比存在窦性心率震荡减弱现象,表明SAHS患者自主神经功能受损,震荡斜率降低可能作为预测SAHS患者发生心血管事件的一项指标。     

动态心电图推导呼吸曲线在老年慢性阻塞性肺疾病合并睡眠呼吸暂停低通气综合征患者中筛查价值的分析

目的:分析动态心电图推导呼吸曲线(EDR)检测在慢性阻塞性肺疾病患者并发睡眠呼吸暂停低通气综合征(SAHS)中的筛查价值。方法:收集选取2017年4月至2019年4月期间,我院诊治的147例老年慢性阻塞性肺疾病患者为研究对象,以多导睡眠监测为SAHS的诊断金标准,同时行动态心电图EDR检测进行对比分析,计算动态心电图EDR检测的诊断特异度、敏感度、准确度,同时绘制受试者工作特征(ROC)曲线图,计算ROC曲线下面积(AUC)。结果:SAHS阳性和SAHS阴性组患者在年龄和性别上,差异无统计学意义(P均>0.05),而两组在BMI、糖尿病和高血压的发生上,差异有统计学意义(P均<0.05);动态心电图EDR与PSG分析结果,异无统计学意义(P>0.05);SAHS阴性和阳性患者7 h内低通气次数和AHI情况,差异有统计学意义(P<0.05);7 h内低通气次数预测SAHS的最佳截断值为30.12次(诊断敏感度为90.4%,特异度为88.3%),其ROC曲线下面积(AUC)为0.824(95%CI:0.782~0.902,P<0.008),AHI预测的最佳截断值为5.18次/h (诊断敏感度为90.3%,诊断特异度为90.1%),其AUC为0.959(95%CI:0.934~0.986,P<0.001), 7 h内低通气次数和AHI截取值的两组人群相比,差异有统计学意义(P均<0.05)。结论:动态心电图EDR检测在慢性阻塞性肺疾病患者SAHS筛查中的参考价值较高,值得在临床上进一步验证使用。     

流式细胞仪检测HLA-B27在脊柱关节病诊断中的应用价值

目的评价流式细胞仪检测人类白细胞抗原-B27(HLA-B27)在脊柱关节病诊断中的应用价值。方法入选的脊柱关节病(SpAs)患者248例[其中强直性脊柱炎(AS)148例,未分化脊柱关节病(USpA)48例,反应性关节炎(ReA)31例,幼年脊柱关节病(JSpA)12例,银屑病关节病(PsA)6例,炎性肠病性关节病(EA)3例];同时抽取非脊柱关节病患者204例作为对照。452例患者均进行流式细胞仪检测HLA-B27。结果 HLA-B27对SpAs的敏感性为85.1%,特异性为94.1%,阳性预测值为94.6%,阴性预测值为83.8%;对AS的敏感性为93.2%,特异性为94.1%,阳性预测值为94.5%,阴性预测值为92.7%;对USpA的敏感性为77.1%,特异性为94.1%,阳性预测值为92.5%,阴性预测值为81.3%;对ReA的敏感性为71.0%,特异性为94.1%,阳性预测值为91.7%,阴性预测值为78.0%。结论流式细胞仪检测HLA-B27对SpAs、AS、USpA、ReA有很高的敏感性、特异性和阳性预测值和阴性预测值,对早期SpAs、AS、USpA、ReA的诊断有重要的应用价值。     

Risk stratification in patients with Brugada syndrome: analysis of daily fluctuations in 12-lead electrocardiogram (ECG) and signal-averaged electrocardiogram (SAECG)

Introduction: Risk stratification between symptomatic and asymptomatic patients with Brugada syndrome is not yet established. We compared daily fluctuations in 12-lead electrocardiogram (ECG) and signal-averaged ECG (SAECG) characteristics between symptomatic and asymptomatic patients with Brugada syndrome to identify new markers for distinguishing between high- and low-risk patients.
Methods and Results: Thirty-five patients with Brugada syndrome underwent ECG and SAECG simultaneously at least 4 times every 3 months. We evaluated daily fluctuations (differences between maximum and minimum values) in ECG and SAECG characteristics and compared them between symptomatic  (N = 11)  , and asymptomatic  (N = 24)  patients. On ECG, the daily fluctuations in r-J interval (interval from QRS onset to J point) in leads V1, V2, and V6 were significantly larger in symptomatic than in asymptomatic patients  (V1; 20 ± 6 vs 10 ± 8 msec, P < 0.01, V2; 22 ± 8 vs 11 ± 4 msec, P < 0.01, and V6; 24 ± 7 vs 14 ± 7 msec, P < 0.01)  . On SAECG, daily fluctuations in filtered QRS (f-QRS) duration and LAS40 were significantly larger in symptomatic than in asymptomatic patients (f-QRS;  15 ± 7 vs 9 ± 4 msec, P < 0.05  , and LAS40;  21 ± 7 vs 10 ± 6 msec, P < 0.05  ).
Conclusions: Instability of depolarization appears to be related to the risk of fatal ventricular arrhythmias in patients with Brugada syndrome. Daily fluctuations in ECG and SAECG characteristics could be useful for distinguishing between high- and low-risk patients with Brugada syndrome.     

Influence of perhexilinmaleat on the exercise electrocardiogram (author's transl)

In 15 patients with angiographically proven coronary heart disease and reproducible exercise induced ischemic ST-segment depression the antianginal effect of Perhexilinmaleat was tested in a cross-over randomized double-blind trial. The patients were treated 4 weeks with a placebo, 2 weeks with 200 mg and 2 weeks with 400 mg/day Perhexilinmaleat. The exercise-induced ischemic ST-segment depression was significantly reduced (p less than 0.001) by Perhexilinmaleat. This calcium-antagonist drug also prolonged the PQ-interval and reduced the heart rate during exercise. Some liver specific enzymes were slightly elevated. These and other side effects more often occurred at the higher dose of 400 mg/day.     

The sleep electrocardiogram at extreme altitudes (Operation Everest II)

To evaluate the effect of sleep at extreme altitudes upon heart rate and rhythm, continuous sleep monitoring was performed in 8 normal young men during a 40-day simulated ascent of Mt. Everest in a hypobaric chamber. Recordings were made for 1 hour before sleep, during sleep and for 1 hour after awakening in all subjects at 760 torr (sea level), in 7 subjects at 390 torr (5,490 m), in 6 at 347 torr (6,100 m) and in 4 at 282 torr (7,620 m). The following results were obtained: periods of sinus bradycardia occurred during sleep in all subjects at 3 altitudes with a mean heart rate of 41 +/- 0.5 beats/min compared to a rate of 44 +/- 2 beats/min at sea level; cycling of the heart rate, presumably due to periodic breathing, occurred in 14 of 17 studies at altitude but not at sea level (cycles consisted of bradycardia [40 beats/min] for 13 seconds and tachycardia [120 beats/min for 5 seconds]; and arrhythmias were observed in all subjects during sleep and consisted of transient bradycardia (heart rates as low as 20 beats/min), sinus pauses frequently associated with escape rhythms and occasional blocked P waves. No arrhythmias were observed at sea level. Simultaneous records of respiration and the electrocardiogram at 12,500 feet (3,810 m) in 5 other normal subjects revealed tachycardia occurring during hyperpnea and bradycardia occurring during apnea. Data indicate that during sleep in normal young subjects at high altitude, cycling of the heart rate with periodic breathing is common, as are bradyarrhythmias. The mechanism of these arrhythmias has yet to be defined.     

口服蒿甲醚32例心电图观测

动物实验和人体现场研究证明蒿甲醚能杀灭进入宿主体内日本血吸虫童虫,不仅可降低人群感染率,减轻感染度,而且还可以防止急性血吸虫病。1996年4-11月,我们在安徽省贵池市唐田乡对920名村民进行蒿甲醚预防血吸虫病现场双盲对照研究中,选择80名村民作治疗前后心电图监测,以观察蒿甲醚对心电的影响,结果如下: