远程心电监测网络系统在区域性医疗中心的应用及效果评价

基于渝东北片区医疗资源匮乏且分布不均、基层医生心电图诊断水平较低的现状,重庆三峡中心医院于2014年6月采取“1＋X”模式,以“四统一”“一共享”为核心,建设了区域性远程心电监测网络诊断-会诊中心,方便区域内的心血管病患者在不同级别的医疗机构都能享受到同质化的心电检查与治疗。本文介绍了该会诊网络的组织及技术架构、工作体系、运行机制与应用成效,分享了系统建设运营的经验与建议,并展望了系统其他应用的深度开发、基于云计算架构的改造与社区居民智慧健康医疗体系的实现。     

远程动态心电图信息系统的临床应用价值

目的：探讨远程动态心电图（telemonitoring ECG,TTECG）信息系统的临床应用价值。方法选取2015年6月至2016年5月分院传至本部心电会诊中心的 Holter 数据63例。将入选患者分为网络传输组（31例）和人工传递组（32例）。用动态心电图记录器在基层医院采集动态心电信息,分别通过人工传递和局域网传输的方式将信息传至医院心电会诊中心,由心电专科医师做出诊断。将开始诊断时间划分为1 h 内、1～5 h 和5～10 h,对不同时间段的诊断例数进行组间对比和分析。结果网络传输组的开始诊断时间明显早于工传递组[（1．2±0．5）h vs．（8．7±2．0）h,P ＜0．05]。当开始诊断时间在1 h 内时,网络传输组共诊断26例（83．9％）,人工传递组0例;在1～5 h 时,两组分别诊断5例（16．1％）和12例（37．5％）;在5～10 h 时,两组分别诊断0例和20例（62．5％）,差异有统计学意义（P ＜0．01）。结论在基层医院应用 TTECG 信息系统可节省患者诊疗时间,实现远程的数据共享与会诊,有利于及时发现心血管事件,提高基层医院诊疗水平,临床实用价值较高。     

远程心电系统在基层医院的应用效果分析

目的 探讨远程心电系统在基层医院的临床应用价值及发展前景.方法 从总院、分院、社区医院及乡镇卫生院通过远程心电网络系统记录并上传的386500份心电图中,随机抽取1000份作为研究对象,根据其资料来源、心电图特征和不同年龄段进行分组分析.结果 1000份网络心电图中533份来自总院,467份来自分院、社区医院和乡镇卫生...     

远程实时心电监测仪与常规心电图在心血管疾病中的监测和对比分析

目的通过对远程实时心电监测仪进行性能测试和临床应用研究,旨在评价远程监测仪记录心电信号的准确性、安全性和有效性,并探讨其临床应用价值。方法人选2008年4月至2008年12月北京阜外心血管病医院194例住院患者。所有受试者均进行远程实时心电监测仪（心电手机）及常规12导联心电图监测,分为远程心电图组及常规心电图组。对两组进行心电图诊断及时间和幅度参数的比较。结果远程心电图组胸前导联的图形质量及基线稳定性相对优于肢体导联。经比较远程心电图组心律失常检出率高（P〈0．05）,共识别出心律失常266例,其中,快速心律失常135例,缓慢心律失常131例,最常见心律失常依次是室性早搏（18．7％）,一度房室阻滞（13．9％）及心房颤动（13．5％）。两组仪器所测得正常心电图组在心率、P波、PR间期、QRS时限、QT间期等参数间差异均无统计学意义,参数相关良好;V2、V3、V5及I导联进行P波振幅、QRS波振幅、QRS综合压代数和压差及T波振幅等参数之间比较差异无统计学意义。结论远程实时心电监测仪心电信号记录准确,能够检测出常见的心律失常及恶性室性心律失常,对心律失常的诊断符合率高,使用可靠、安全。     

心房颤动射频消融术后远程心电监测随访的意义

目的通过电话心电远程监测心房颤动（房颤）射频消融术后复发情况,探讨远程心电监测仪诊断心律失常的临床价值。方法自2009年10月至2010年4月在我院行房颤射频消融术患者72例,其中持续性房颤39例、阵发性房颤33例。患者在消融术后第1天及每3个月均接受24h动态心电图检查,同时术后每天定时及有症状时接受电话远程传输心电图（TTECG）监测。比较两种检测方法记录的房颤复发情况及房颤发生与症状的相关性。结果随访（11．0±2．3）个月,TTECG共检测到4403份无干扰心电图,3610份窦性心电图中有症状的1351份（37．43％）。793份异常心电图中无症状性发作的214份（26．99％）。术后3个月空白期中,24h动态心电图发现17例（23．61％）房颤复发,TrECG发现31例复发,差异有统计学意义（P=0．004）。随访期间,24h动态心电图发现9例房颤患者复发,TTECG发现18例复发,差异有统计学意义（P=0．033）。通过TTECG的监测,与空白期的复发率比较,1年后房颤复发率明显下降（P=0．022）,而24h动态心电图未发现复发率的差异（P=0．083）。通过24h动态心电图及TTECG监测,持续性房颤消融成功率分别为84．62％,71．79％（P=0．000）,阵发性房颤消融成功率分别为90．91％,78．79％（P=0．006）。结论对于心律失常尤其是射频消融术后房颤的监测,电话远程心电监测优于常规24h动态心电监测,能及时发现术后房性心律失常复发,尤其是无症状性房颤。术后有症状患者也不一定是真正的房颤复发,实际为窦性心律。     

学术动态

中国医师协会和中国心电学会联合举办的心电技术规范化培训新一届培训班于2013年6月28～30日在涿州中医医院举办。中国心电图会诊中心涿州分中心成立一年来,通过远程会诊,在心电图诊疗水平和诊疗时效方面都取得了显著提升。     

农村远程心电监测的应用

目的 探讨农村远程心电监测技术和服务模式的应用及临床意义.方法 沂源县中医院在宽带网上申请设立IP心电远程会诊中心,中心下设终端分站,分站将所采集到的心电图信息通过宽带网传至中心,中心医生即刻作出诊断并回复.选择自2009年8月～2010年7月,我中心监测的异常心电图9353例为1组,心律失常3758例为Ⅱ组,异常ST...     

经手机微信行心电远程会诊的应用

目的探讨建立农村手机微信心电远程会诊的应用价值。方法沂源县中医院医师在手机上申请设立IP心电远程会诊中心(微信群主)一处,中心下设终端分站群(网点),分站群将所采集到的心电图信息经手机拍照后,通过手机微信传至中心,中心医生即刻作出诊断并回复。结果自2016年1月至12月共收集微信诊断静态常规心电图1035例,男612例,女423例,年龄12~94岁,其中正常心电图323例,异常心电图712例,阳性率68.8%,心律失常357例,阳性率34.5%,异常ST-T改变410例,阳性率39.6%,心肌梗死9例,阳性率0.86%。由群点转入我院治疗的病人76例,抢救群点急危重症病人47例,医院专家通过手机微信对农村卫生室首诊的复杂病症患者给予了91人次的远程指导性治疗方案的提供,结果表明,全县63个农村站群点实现了心电图诊断标准化,实现了远程会诊、分级医疗和双向转诊的医疗服务。急性心肌梗死患者因即可获知病情并及时救治,死亡率降低。结论农村手机微信心电远程监测会诊的建立,实现了以基层医疗卫生服务手机微信为基础的医疗服务体系的公共卫生服务功能,建立了信息互通、农村卫生室首诊、分级医疗的服务体系。实现了在手机微信上快速、及时、准确的心电图诊断报告发送。缩短了急性心肌梗死的救治时间,降低了急性心肌梗死的死亡率。     

心电散点图诊断晚发房性早搏的临床应用价值

目的 研究心电散点图在晚发房性早搏(APB)诊断中的应用价值。 方法 回顾性分析从2017年12月 ~ 2019年5月于我院进行诊治的疑似晚发APB-200例患者，对所有患者均进行心电散点图以及常规心电图检查，对比不同检查方式诊断晚发APB的灵敏度、特异度和准确度。此外，回顾性分析同期我院收治的晚发APB以及窦性心律不齐不明确患者80例，比较心电散点图以及常规心电图的误诊率情况。 结果 心电散点图诊断晚发APB的灵敏度为93%、特异度为95%，准确度为94%，相比常规心电图的82%、79%、82%有显著差异（P < 0.05，P < 0.01），心电散点图的漏诊率(7%)和误诊率（5%）显著低于常规心电图（分别18%和21%，均P < 0.05）。 结论 心电散点图应用于晚发APB诊断中具有较高的灵敏度、特异度和准确度，较低的漏诊率和误诊率，值得临床推广应用。     

心血管病专科医院开展心电图远程会诊的价值

目的:探讨基层医疗机构心电图远程会诊的价值。方法:对湖北省监利县不同级别医疗机构的远程心电图会诊资料进行统计分析。结果:(1)该地区县级医院心电图会诊病例共1334例,阳性率41.00%(547/1334),异常心电图类型发生率较高的前三种依次为心律失常(27.29%)、左心室肥厚(9.15%)、ST-T改变(2.62%);(2)各乡村卫生室会诊病例共723例,阳性率55.19%(399/723),异常心电图类型发生率较高的前三种依次为心律失常(34.02%)、ST-T改变(11.07%)、左心室肥厚(5.39%)。结论:远程心电图会诊简便易行,可提高缺乏心电图设备、人才的农村地区的一过性异常心电事件的检出率,便于早期治疗,改善预后,值得推广。     

西南部分地区远程心电检测与动态心电图的对比分析

目的分析中心数据库远程动态心电(TTECG)检测资料与普通动态心电图(Holter)检测资料进行对比观察。方法选择本院心脏远程监护中心进行TTECG检查与Holter检查的病人,从2007年7月至2010年11月各26 625例患者。结果 TTECG正常3 678(13.83%),心律失常者22 914(86.17%),其中3例患者死亡,分别是室性心动过速(1例)、房室传导阻滞(1例)、交界性逸搏(1例)。Holter正常3 736例(14.06%),心律失常22 834例(85.94%),其中15例患者死亡,分别是室性心动过速(4例)、病窦综合征(7例)、房室传导阻滞(4例)。结论TTECG检测的优势为及时发现致命性心律失常,及时预警治疗,减少死亡。     

18例肺栓塞患者心电图分析

目的分析心电图改变在肺栓塞诊断中的作用。方法对18例肺栓塞患者的心电图进行分析。结果心电图正常3例,心电图异常15例,其中窦性心动过速7例(38.89%),SⅠQⅢTⅢ征5例(27.78%),完全性或不完全性右束支传导阻滞5例(27.78%),额面电轴右偏4例(16.67%),顺钟向转位3例(16.67%),ST段改变11例(61.11%),T波倒置11例(61.11%),肺型P波2例(11.11%),aVR导联出现终末R波7例(38.89%),房性心律失常4例(22.22%)。结论心电图在临床肺栓塞的诊断中表现为非特异性和非诊断性,但有许多征象对提示肺栓塞有一定价值,尤其应结合临床注意观察心电图动态改变,有助于进行早期诊断和鉴别诊断,减少漏诊率和误诊率。     

海拔2200米以上10000例健康体检心电图结果分析

目的 分析海拔2200米以上干部职工健康体检者心电图的异常发生率,以早期发现、预防、诊断、治疗心血管疾病.方法 采用瑞士希勒自动分析心电图仪,在体检者安静休息状态下作常规12导联描记,时间20s左右.结果 本组有10000例中正常8378例(83.8%),异常1622(16.2%).异常心电图检出率随年龄增高而递增.结论 心电图检测在正常体检中是不可缺少的项目,对早期发现、预防、诊断、治疗心血管疾病必不可缺少.     

Automated serial ECG comparison improves computerized interpretation of 12-lead ECG

Background

Interpretation of a patient's 12-lead ECG frequently involves comparison to a previously recorded ECG. Automated serial ECG comparison can be helpful not only to note significant ECG changes but also to improve the single-ECG interpretation. Corrections from the previous ECG are carried forward by the serial comparison algorithm when measurements do not change significantly.

Methods

A sample of patients from three hospitals was collected with two or more 12-lead ECGs from each patient. There were 233 serial comparisons from 143 patients. 41% of patients had two ECGs and 59% of patients had more than two ECGs. ECGs were taken from a difficult population as measured by ECG abnormalities, 197/233 abnormal, 11/233 borderline, 14/233 otherwise-normal and 11/233 normal. ECGs were processed with the Philips DXL algorithm and then in time order for each patient with the Philips serial comparison algorithm. To measure accuracy of interpretation and serial change, an expert cardiologist corrected the ECGs in stages. The first ECG was corrected and used as the reference for the second ECG. The second ECG was then corrected and used as the reference for the third ECG and so on. At each stage, the serial comparison algorithm compared an unedited ECG to an earlier edited ECG. Interpretation accuracy was measured by comparing the algorithm to the cardiologist on a statement by statement basis. The effect of serial comparison was measured by the sum of interpretive statement mismatches between the algorithm and cardiologist. Statement mismatches were measured in two ways, (1) exact match and (2) match within the same diagnostic category.

Results

The cardiologist used 910 statements over 233 ECGs for an average number of 3.9 statements per ECG and a mode of 4 statements. When automated serial comparison was used, the total number of exact statement mismatches decreased by 29% and the total same-category statement mismatches decreased by 47%.

Conclusion

Automated serial comparison improves interpretation accuracy in addition to its main role of noting differences between ECGs.     

A prospective study on spontaneous fluctuations between diagnostic and non-diagnostic ECGs in Brugada syndrome: implications for correct phenotyping and risk stratification.

AIMS: Fluctuations between the diagnostic ECG pattern and non-diagnostic ECGs in patients with Brugada syndrome are known, but systematic studies are lacking. The purpose of this study was to prospectively evaluate the spontaneous ECG changes between diagnostic and non-diagnostic ECG patterns in patients diagnosed with Brugada syndrome. METHODS AND RESULTS: In 43 patients with Brugada syndrome (27 males; mean age 45+/-11 years), 310 resting ECGs were obtained during a median follow-up of 17.7 months. The ECGs were analysed for the presence of coved type, saddle-back type or no, respectively unspecific, changes. A coved-type ECG pattern with more than 2 mm ST-segment elevation in at least two right precordial leads was defined as diagnostic. The patients were compared for different clinical characteristics with respect to the pattern of fluctuations. Out of a total of 310 ECGs, 102 (33%) revealed a coved type, 91 (29%) a saddle-back type, and 117 (38%) a normal ECG. Fifteen patients (35%) initially presented with a diagnostic coved-type ECG. Fourteen patients (33%) with an initially coved-type ECG exhibited intermittently non-diagnostic ECGs during follow-up. Only one patient (2%) presented constantly with a coved-type ECG. Out of 28 patients (65%) with an initially non-diagnostic ECG, eight (19%) patients developed a diagnostic coved-type ECG during follow-up. Twenty patients (47%) revealed a coved-type ECG during ajmaline challenge, but never had a baseline coved-type ECG recorded. No significant differences were found in gender and clinical characteristics among patients with or without fluctuations between diagnostic and non-diagnostic basal ECGs. The rate of inducible ventricular fibrillation was significantly higher in patients with more than 50% coved-type ECGs than in patients with less than 50% diagnostic ECGs. CONCLUSION: The prevalence of fluctuations between diagnostic and non-diagnostic ECGs in patients with Brugada syndrome is high and may have an implication on the correct phenotyping and on the risk stratification in patients with Brugada syndrome without aborted sudden cardiac death. For correct phenotyping and risk stratification, repetitive ECG recordings seem to be mandatory.     

Common errors in computer electrocardiogram interpretation

OBJECTIVE: The aim of the study was to determine the frequency and nature of errors in computer electrocardiogram (ECG) reading. METHODS: The ECGs were collected in the tertiary care VA Hospital from both inpatients and outpatients. They were read by the electrocardiograph built-in computer software, and then reread by two cardiologists. Statistical analysis was performed using sensitivity, specificity, positive and negative predicted value to analyze the data. An error index was formulated as indicator of diagnostic accuracy. RESULTS: Out of 2072 ECGs, 776 (37.5%) were normal, and 1296 (62.5%) were abnormal. In 9.9% of all ECGs and in 15.9% of abnormal ECGs there were significant disagreements between the computer and cardiologists. The errors in diagnosis of arrhythmia, conduction disorders and electronic pacemakers accounted for 178 cases, or 86.4% of all errors. The rest was represented by misdetection of chamber enlargement (7 cases, 3.4%), misdiagnosis of ischemia and acute myocardial infarction (16 cases, 7.8%), and lead misplacement (5 cases, 2.4%). CONCLUSIONS: The most frequent errors in computer ECG interpretation are related to arrhythmias, conduction disorders, and electronic pacemakers. Computer ECG diagnosis of life threatening conditions e.g. acute myocardial infarction or high degree AV blocks are frequently not accurate (40.7% and 75.0% errors, respectively). Improvement in the diagnostic algorithms should focus on these areas. Error index is a convenient and informative tool for evaluation of diagnostic accuracy.     

急诊糖尿病酮症酸中毒误漏诊临床分析

目的提高对急诊不典型糖尿病酮症酸中毒的认识,减少误漏诊的发生。方法收集近4年来该院急诊科收治的22例糖尿病酮症酸中毒病例资料,对其中4例误诊漏诊病例临床资料进行回顾性分析。结果22例病例中出现4例误诊漏诊,误诊漏诊率为18．2％。4例误诊漏诊患者人院时主诉均未提及糖尿病病史,此次发病时间短,来诊时无典型糖尿病酮症酸中毒症状、体征。结论对急诊患者,要加强病史询问,全面体检,加强血糖、血生化、尿生化检查,可降低糖尿病酮症酸中毒误诊漏诊率。     

Diagnostic values of different ECG durations in paroxysmal AF diagnosis

ObjectiveTo evaluate the application value of different‐duration electrocardiograms (ECGs) in paroxysmal atrial fibrillation (AF) diagnosis.MethodsA total of 220 patients with paroxysmal atrial fibrillation diagnosed by 24‐h dynamic electrocardiogram in our hospital from January 2019 to December 2020 were selected as the study subjects. The patients were monitored for 10 s, 5 min, and 24 hr, respectively. The results of the three different‐duration ECGs were compared and analyzed in order to evaluate their paroxysmal AF diagnosis value.ResultsParoxysmal AF was detected in 18 patients (8.2%) with the 10‐s ECG; in 89 patients (40.5%) with the 5‐min ECG; and in 199 patients (90.5%) with the 24‐h dynamic ECG.ConclusionIn patients with paroxysmal AF, ECGs with longer detection times had higher detection rates.     

Support of Daily ECG Procedures in a Cardiology Department via the Integration of an Existing Clinical Database and a Commercial ECG Management System

Background: In the context of HYGEIAnet, the regional health telematics network of Crete, a clinical cardiology database (CARDIS) has been installed in several hospitals. The large number of resting ECGs recorded daily made it a priority to have computerized support for the entire ECG procedure. Methods: Starting in late 2000, ICS‐FORTH and Mortara Instrument, Inc., collaborated to integrate the Mortara E‐Scribe/NT ECG management system with CAROIS in order to support daily ECG procedures. CARDIS was extended to allow automatic ordering of daily ECGs via E‐Scribe/NT. The ECG order list is downloaded to the electrocardiographs and executed, the recorded ECGs are transmitted to E‐Scribe/NT, where confirmed ECG records are linked back to CARDIS. A thorough testing period was used to identify and correct problems. An ECG viewer/printer was extended to read ECG files in E‐Scribe/NT format. Results: The integration of E‐Scribe/NT and CARDIS, enabling automatic scheduling of ECG orders and immediate availability of confirmed ECGs records for viewing and printing in the clinical database, took approximately 4 man months. The performance of the system is highly satisfactory and it is now ready for deployment in the hospital. Conclusions: Integration of a commercially available ECG management system with an existing clinical database can provide a rapid, practical solution that requires no major modifications to either software component. The success of this project makes us optimistic about extending CARDIS to support additional examination‐procedures such as digital coronary angiography and ultrasound examinations. A.N.E. 2002;7(3):263–270