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。     

远程心电监测在社区居民中的应用

3 328例接受远程心电记录仪检查的患者,正常者1 292例,异常者2 036例。异常心电图主要包括复极异常、传导阻滞、窦性心动过缓、心房颤动、心肌缺血等。1578例患者合并有多种心电异常。结论:远程心电记录仪操作方便,可发现多种心律失常。     

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。     

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。     

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...     

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。     

中国远程心电监测网络体系简介

众所周知，目前心脑血管疾病已成为威胁人类健康的“第一杀手”。     

远程心电监测对于心房颤动筛查与监测的应用

运用于心房颤动(简称房颤)的筛查和监测有12导联常规心电图、24 h动态心电图以及便携式或可穿戴式心电设备、心脏电子植入装置。便携式或穿戴式心电设备的应用明显提高了房颤的检出率。远程心电监测尚存在心电数据标准化、数据库的存储、未与互联网大数据结合等问题。     

健康监护平台的构建及其在社区慢性病管理中的应用

健康监护平台是一个集多种信息技术及医疗技术于一体的医疗信息系统,主要用于社区慢性病实时监测,整合区域医疗资源,为社区慢性病患者提供连续的、个性化的健康服务,提高慢性病防控效果。本文对坪山新区人民医院试行的健康监护平台的构建及其在社区慢性病管理中的应用情况进行分析与总结。     

基于移动通讯技术的新型院外远程实时心电监测系统的临床研究

目的 评价一种自主研发的基于移动通讯技术的新型院外远程实时心电监测系统数据传输的实时性及对心律失常检测的敏感性.方法 通过测定心电信号传输的延时评估系统的实时性;通过与动态心电图对比评估远程监测对心律失常检测的敏感性.结果 远程监测时心电数据传输的最短延时为9s,最长延时为17s,平均延时为（13.4±4.5）s.在100例受试者中,远程监测和动态心电图分别检测到偶发房性期前收缩62例、57例,频发房性期前收缩22例、25例,心房颤动均为9例,非阵发性室性心动过速16例、12例,差异均无统计学意义（均P ＞0.05）.同时均发现二度Ⅱ型房室传导阻滞5例、三度房室传导阻滞2例.结论 该系统有较好的实时性,对心律失常检出的敏感性与动态心电图相仿.     

重型颅脑损伤患者肌钙蛋白和心电图的变化及意义

目的：探讨重型颅脑损伤后肌钙蛋白及心电图的变化,了解隐匿性心肌损伤的发生率。方法：监测89例重型颅脑损伤患者血清心肌肌钙蛋白（cTnI）的水平,分析患者血清cTnI与心肌损伤、GCS评分、病死率的关系。结果：89例重型颅脑损伤患者有68例（76．4％）存在cTnI的升高,cTnI水平与（X2S评分成正相关,cTnI值越高,病死率越高,74例（83．15％）出现心电图异常。结论：重型颅脑损伤患者可出现不同程度的心肌损害,cTnI比心电图更能反映脑外伤患者的心肌损伤。     

多巴酚丁胺负荷心电图试验对冠心病的临床诊断价值

对60例可疑冠心病者进行多巴酚丁胺负荷心电图试验，以冠状动脉造影为标准评价该试验对冠心病的诊断价值。判定标准以J点后0．08秒ST段偏移0．1mV以上为阳性，诊断冠心病的敏感性，特异性、准确度分别为75．7％，78．7％和76．6％。对冠脉单支、双支和三支病变诊断的敏感性分别为52．6％、100％和100％。试验中未发现明显的不良反应，显示本试验是一种安全可行、准确性较好的诊断冠心病的无创检查方法，并可在基层医院推广应用。     

心电图在急性肺栓塞诊断治疗中的价值

目的 探讨心电图在急性肺栓塞诊断治疗中的价值.方法 对30例急性肺检塞患者心电图表现进行分析.结果 30例患者心电图均有改变,表现各异.结论 心电图对肺栓塞的诊断具有比较重要的价值.多次心电图检查观察动态变化并结合临床进行全面分析,综合判断,对PTE诊断和预后的判断有更大意义.     

Normal standards for computer-ECG programs for prognostically and diagnostically important ECG variables derived from a large ethnically diverse female cohort: The Women's Health Initiative (WHI)

Background

Substantial new information has emerged recently about the prognostic value for a variety of new ECG variables. The objective of the present study was to establish reference standards for these novel risk predictors in a large, ethnically diverse cohort of healthy women from the Women's Health Initiative (WHI) study.

Methods and Results

The study population consisted of 36,299 healthy women. Racial differences in rate-adjusted QT end (QT_ea) and QT peak (QT_pa) intervals as linear functions of RR were small, leading to the conclusion that 450 and 390 ms are applicable as thresholds for prolonged and shortened QT_ea and similarly, 365 and 295 ms for prolonged and shortened QT_pa, respectively. As a threshold for increased dispersion of global repolarization (T_peakT_end interval), 110 ms was established for white and Hispanic women and 120 ms for African-American and Asian women. ST elevation and depression values for the monitoring leads of each person with limb electrodes at Mason-Likar positions and chest leads at level of V1 and V2 were first computed from standard leads using lead transformation coefficients derived from 892 body surface maps, and subsequently normal standards were determined for the monitoring leads, including vessel-specific bipolar left anterior descending, left circumflex artery and right coronary artery leads. The results support the choice 150 μV as a tentative threshold for abnormal ST-onset elevation for all monitoring leads. Body mass index (BMI) had a profound effect on Cornell voltage and Sokolow–Lyon voltage in all racial groups and their utility for left ventricular hypertrophy classification remains open.

Conclusions

Common thresholds for all racial groups are applicable for QT_ea, and QT_pa intervals and ST elevation. Race-specific normal standards are required for many other ECG parameters.     

The 24-lead ECG display for enhanced recognition of STEMI-equivalent patterns in the 12-lead ECG

In a patient with chest pain and suspected acute coronary syndrome, the electrocardiogram (ECG) is the only readily available diagnostic tool. It is important to maximize its usefulness to detect acute myocardial ischemia that may evolve to myocardial infarction unless the patient is treated expediently with reperfusion therapy. Since diagnostic guidelines have usually included only ST-elevation myocardial infarction (STEMI) as the entity that should be diagnosed and treated urgently, a patient with coronary occlusion represented on ECG as ST depression is likely not to be considered a candidate for receiving immediate coronary angiography and coronary intervention. ECG criteria for STEMI detection require that ST elevation meet predetermined millivolt thresholds and appear in at least two spatially contiguous ECG leads. The typical ECG reader recognizes only three contiguous pairs: aVL and I; II and aVF; aVF and III. However, viewing the “orderly sequenced” 12-lead ECG display, two more contiguous pairs become obvious in the frontal plane: + I and − aVR; − aVR and + II. The 24-lead ECG is a display of the standard 12-lead ECG as both the classical positive leads and their negative (inverted) counterparts. Leads + V1, + V2, + V3, + V4, + V5, and + V6 and their inverted counterparts are used to generate a “clock-face display” for the transverse plane. Similarly, + aVL, + I, − aVR, + II, + aVF, + III in the frontal plane and their inverted counterparts are used to generate a clock-face display for the frontal plane. Optimum results, 78% sensitivity and 93% specificity, were obtained using the following 19 ECG leads: frontal plane: + aVR, − III, + aVL, + I, − aVR, + II, + aVF, + III, − aVL; transverse plane: + V1, + V2, + V3, + V4, + V5, + V6, − V1, − V2, − V3.