甲状腺功能亢进症治疗前后心电监测分析

观察63例甲亢病人治疗前连续24h心电监测及治疗后29例病人重复检查之结果,发现甲亢患者可有各种心电图改变,伴心律失常者为69.8％,窦性心动过速占60.3％,睡眠时心率均比醒觉时慢,但二者治疗前后心率下降的幅度相似。治疗后心律大多正常,但2例甲状腺功能恢复正常时出现早博。上述情况可能与血清甲状腺激素水平直接有关。     

老年人心电监测1000例心律失常分析

我院自 1993年起开展了对有心慌不适的门诊老年患者在常规 12导联心电图检查的基础上加做 0 5ｈ以上的持续心电图监测 ,以弥补常规心电图记录时间短暂的缺陷 ,使心律失常检出率大大提高。本文收集了≥ 60岁患者 10 0 0例的心电监测结果 ,并进行了分类、分析 ,旨在不断提高人们对老年人发生心律失常的类型及发生率的认识。1　对象与方法1 1　对象　受检对象 10 0 0例 ,男 5 14例 ,女 486例 ,年龄 60～ 90岁 ,平均 ( 65 2 5± 6 45 )岁 ,10 0 0例受检者中 2 60例有高血压病史或冠心病病史 ,占总例数 2 6% ,肺心病、糖尿病 2 49例 ,占总例数 …     

心电监测在介入性诊疗中的价值

介入性检查和治疗的应用范围越来越广 ,已经成为临床诊疗的重要组成部分。为加强安全性 ,我们对部分病例在介入性诊治中作心电监测 ,现报告如下。资料和方法６０例接受心电监测的病例 ,男性４１例 ,女性１９例 ,年龄６～７６(５１．０±１９．２)岁。介入性诊治项目包括 :右心造影２８例 ,肝动脉造影与栓塞１７例 ,支气管动脉造影与栓塞１１例 ,四肢血管造影和食管内支架放置各２例。患者平卧于Ｘ线检查床上 ,按照标准１２导联敷电极和连接导联线。用上海医用电子仪器厂产ＸＪＪ＿１１型心电监护仪。对受检者作心电屏幕持续监测 ,在导管或导…     

手机心电远程监测进展

随着信息现代化的发展，采用手机或手机方式的通讯技术进行心电远程监测，已获得成功，是心电监测学发展的重要方向之一。这项技术的推广，对心血管病防治工作的发展具有里程碑意义，使整个地球村作为一个大心脏监护室的目标将成为可能。本文简要介绍当前主要的发展方向和取得的新成果。     

不同麻醉方法对电子支气管镜检查效果分析

目的探讨3种不同麻醉方法应用于电子支气管镜检查的临床效果。方法在我科2013年1月至6月接受普通电子支气管镜检查的l128例患者中随机抽取300例患者为研究对象,根据麻醉方式的不同分为3组（A组为利多卡因咽喉喷雾法＋氧气雾化吸人法,B组为利多卡因咽喉喷雾法＋利多卡因气管内吸人法,C组为丁卡因咽喉喷雾法＋利多卡因气管内吸人法）,每组100例。观察记录患者一般资料、麻醉效果、检查前及检查进行i0min时患者生命体征的变化、检查过程中的不良反应、咳嗽反射、患者及操作医师的满意度等。结果C组检查前与检查进行i0min时生命体征波动最小,与A组和B组比较差异有统计学意义（P〈O．05）。检查过程中C组不良反应的咳嗽的发生率明显低于A组和B组,患者及医师操作满意度评分明显高于A组和B组（P〈O．05）。A组麻醉优良率为53％,B组优良率为73％,C组优良率为96％,C组与A、B组相比,差异有统计学意义（P〈0．05）。结论3种麻醉方法以丁卡因咽喉喷雾法＋利多卡因气管内吸人方法最优,患者舒适度和安全性最佳,不良反应最少,患者满意度最高,该方法值得临床推广应用。     

城乡远程心电监测效果分析

目的研究城乡远程心电监测的效果。方法选择山西省6个县乡和6个城市社区卫生服务站1997例受检者,比较心律失常检出率、就医费用及就医时间。结果县乡组比社区组受检者心律失常检出率高,就医费用高,就医时间长（P〈0．05）。结论县乡开展远程心电监测检查可节省更多就医成本,效果更明显。     

动态心电图在纤维支气管镜检查中的监测分析

目的　探讨纤维支气管镜检查对心血管系统的影响。方法　在纤维支气管镜检查全程中使用HOL TER监测 ,包括术前、麻醉、活检、刷检、术后等各个环节 ,进行心电动态监护记录并立即回放分析 ,分析各个操作环节的心电变化。结果　两组 2 0 8例检查中发生心动过速、心律失常分别为 15 %和 18.5 %、ST- T变化分别为 2 6 %和 2 7.7%。但两组没有显著性差异 (P>0 .0 5 )。结论　纤支镜检查一般不引起严重的心血管系统并发症 ,通过 DCG监测分析为纤维支气管镜检查的操作者提供具有参考意义的适应症标准     

农村远程心电监测心肌梗死的临床分析

目的探讨农村及社区急性心肌梗死发病及死亡规律。方法采用远程心电监测会诊的方法,入选确诊急性心肌梗死患者65例（监测组）,分析入选患者四季及每天时间发病及死亡情况。选择同期门诊确诊的急性心肌梗死21例患者（门诊组）,对两组急性心肌梗死的发病情况进行对比分析。结果研究期间共监测、会诊农村及社区远程终点患者心电图14591例,确诊急性心肌梗死65例（0.44）,其中5例急性心肌梗死患者死亡,死亡率为7.69（5/65）,低于门诊组急性心肌梗死患者的死亡率（14.28,3/21）,但两组间的差异并无统计学意义（P〉0.05）。农村与社区急性心肌梗死易发时间为冬季（构成比为40）、每天晨起5：00～10：00（构成比为36.9）,监测组与门诊组患者急性心肌梗死发病的四季构成比及每天发病的时间构成比,两组间的差异均无统计学意义（P均〉0.05）。结论农村及社区急性心肌梗死易发时间为冬季、晨起,远程心电监测对降低急性心肌梗死的死亡率有帮助。     

老年高血压病的动态血压与心电监测

目的 探讨老年高血压病患者的血压与心律状态。方法 通过动态血压监测与动态心电监测对80例老年高血压病患者和40例对照组的血压与心电参数进行对比分析。结果 24 h、日间、夜间的平均收绾压和舒张压、血压负荷值等参数老年高血压组明显高于老年对照组,且Ⅲ期平均血压夜间下降百分率明显减低;Ⅱ、Ⅲ期老年高血压病患者其平均心率、缺血型ST-T改变、心脏扩大及心律失常检出率明显高于对照组。结论 老年高血压病患者平均收缩压和舒张压明显增高,血压昼夜节律消失者Ⅲ期明显增多,Ⅱ、Ⅲ期患者伴有明显的心脏扩大、心肌缺血及较严重的心律失常,易促发急性心脏事件。     

Electrocardiographic artifacts during electroconvulsive therapy

Electrocardiographic (ECG) artifacts occur with the use of internal or external monitoring and therapeutic devices. Other common cause of ECG artifact is patient's motion. Electrocardiographic artifact during electroconvulsive therapy is not reported in the literature. We report ECG artifacts due to 2 different mechanisms in the same patient.     

Comparison of 24-hour Holter Monitoring with 14-day Novel Adhesive Patch Electrocardiographic Monitoring

Background

Cardiac arrhythmias are remarkably common and routinely go undiagnosed because they are often transient and asymptomatic. Effective diagnosis and treatment can substantially reduce the morbidity and mortality associated with cardiac arrhythmias. The Zio Patch (iRhythm Technologies, Inc, San Francisco, Calif) is a novel, single-lead electrocardiographic (ECG), lightweight, Food and Drug Administration–cleared, continuously recording ambulatory adhesive patch monitor suitable for detecting cardiac arrhythmias in patients referred for ambulatory ECG monitoring.

Methods

A total of 146 patients referred for evaluation of cardiac arrhythmia underwent simultaneous ambulatory ECG recording with a conventional 24-hour Holter monitor and a 14-day adhesive patch monitor. The primary outcome of the study was to compare the detection arrhythmia events over total wear time for both devices. Arrhythmia events were defined as detection of any 1 of 6 arrhythmias, including supraventricular tachycardia, atrial fibrillation/flutter, pause greater than 3 seconds, atrioventricular block, ventricular tachycardia, or polymorphic ventricular tachycardia/ventricular fibrillation. McNemar's tests were used to compare the matched pairs of data from the Holter and the adhesive patch monitor.

Results

Over the total wear time of both devices, the adhesive patch monitor detected 96 arrhythmia events compared with 61 arrhythmia events by the Holter monitor (P < .001).

Conclusions

Over the total wear time of both devices, the adhesive patch monitor detected more events than the Holter monitor. Prolonged duration monitoring for detection of arrhythmia events using single-lead, less-obtrusive, adhesive-patch monitoring platforms could replace conventional Holter monitoring in patients referred for ambulatory ECG monitoring.     

Electrocardiographic criteria for detecting coronary artery disease in hypertensive patients with ST-segment changes during exercise testing

Purpose

It is well known that patients with arterial hypertension frequently present with ischemic electrocardiographic changes during exercise testing without actually having coronary artery disease (CAD). The purpose of this study was to establish additional electrocardiographic criteria during exercise testing for detecting CAD in hypertensive patients with ischemic ST-segment response.

Methods

Three hundred eighty-two consecutive hypertensive patients (224 males, 58 ± 8 years) who presented with ischemic electrocardiographic changes during exercise testing and agreed to undergo coronary arteriography were included in the study.

Results

From 382 hypertensive patients undergoing coronary angiography, only 76 (20%) had significant coronary stenosis, whereas 306 (80%) had normal coronary arteries. From 382 patients, 287 (75%) (group A) presented with ST-segment depression during exercise in leads II-III-aVF-V₆, 271 (94%) of which had normal arteries at the angiography. The remaining 95 patients (25%) (group B) of the studied patients presented with ST-segment depression in II-III-aVF and/or V₄ through V₆, 60 (63%) of which had CAD. Furthermore, 251 patients of group A presented with ST-segment depression during the fourth to sixth minute of the recovery period in V₄ through V₆, 247 (98%) of which had normal arteries. Another 28 patients from group B presented with ST-segment depression during the fourth to eighth minute of the recovery period in V₄ through V₆, 22 (79%) of which had significant coronary artery stenosis.

Conclusions

Hypertensive patients who present with ST-segment depression during exercise in leads II-III-aVF and/or V₄ through V₆ and with a prolonged duration of this depression at the recovery phase (fourth to eighth minute) are more likely to have CAD. Absence of ST-segment depression in V₄ and V₅ at the end of exercise or during the seventh and eighth minute of recovery favors a false-positive result.     

Electrocardiographic artifact due to a mobile phone mimicking ventricular tachycardia

A case of electrocardiographic artifact due to mobile a phone mimicking ventricular tachycardia was presented. The artifact was discriminated by close scrutiny of ECG and was attributed to a mobile phone because it was simultaneous with mobile phone game.     

Troponin Testing in Patients Without Chest Pain or Electrocardiographic Ischemic Changes

Background

Although often recommended by experts, it is unclear if elevated troponin measurements have clinical utility in patients without chest pain or ischemic electrocardiographic changes.

房室旁束心电图定位的规则系统

目的 研究房室旁束心电图定位的新规则系统.方法 将全心分为10个区域,每区样本26～64例,累积射频导管消融成功的单支房室旁束358例.采用δ波初始20ms极性、QRS形态、R / S比值和QRS终末波极性等作为该规则系统的定位指标.结果 本规则系统对单支房室旁束定位的敏感度为90.2%,特异度97.3%,定位正确率96.6%.结论 90%以上的房室旁束可通过本规则系统从6道同步体表心电图作出正确定位.提高定位正确率的关键是必须重视心电图记录质量,消除干扰,保持基线平稳.     

心电标测图对心肌病的诊断和鉴别诊断

目的：探讨心电峰值标测图（ＥＰＭ）对原发性心肌病（ＣＭＰ）的诊断和鉴别诊断。方法：应用ＥＰＭ对ＣＭＰ（ｎ＝６４）、心肌梗死（ｎ＝８０）、高血压病（ｎ＝４３）和克山病（ｎ＝３１）作ＱＲＳ－Ｔ等电位图和Ｒ等时图分析。结果：ＣＭＰ的特征为异常Ｑ图、多Ｒ、多Ｓ中心和Ｒ图凹陷；Ｒ、Ｓ或Ｑ中心电位值异常增大；Ｔ图分布异常；Ｒ等时线延迟。心肌梗死的特征是异常Ｑ图周围有梗死周围阻滞。高血压病常见Ｑ图和Ｔ图局部异常，克山病常见Ｑ图异常、多Ｓ中心和Ｔ图异常。结论：根据ＥＰＭ的表现有助于对ＣＭＰ作出早期诊断和鉴别诊断。