B／S模式下动态心电系统开单及检查结果的设计与实现

介绍了动态心电系统的设计方案，以MYSQL为后台数据库，前台开发语言C#，电子开单、查询图文报告采用ASP．Net技术，突破了心电设备本身的限制，实现了临床业务的简便化、快捷化。     

冠脉造影联合动态心电图监测在老年冠心病患者诊断中的价值

目的探讨冠脉造影联合动态心电图监测在老年冠心病诊断中的临床应用价值。方法选取来我院进行诊治的以胸闷、胸痛症状为主的拟诊为冠心病的老年患者76例,所有患者均采取冠脉造影联合动态心电图监测的方式进行诊断。结果76例患者中,60例患者的冠脉造影结果为阳性,16例患者的冠脉造影结果为阴性;56例患者的动态心电图监测结果为阳性,20例患者的动态心电图监测结果为阴性。以冠脉造影阳性结果来判断患者为冠心病,则动态心电图监测对老年患者冠心病诊断的敏感性为73．7％（56／76）,特异性为26.3％（20／76）。患者的冠状动脉病变程度和动态心电图持续性ST段低压的阳性率不存在显著关系（P〉0．05）。结论单纯采用动态心电图监测对老年冠心病的诊断并没有太高的应用价值,笔者建议,在临床中应用持续性ST段压低进行冠心病诊断时,需格外谨慎,综合多方面的情况进行诊断,必要时给予冠脉造影进行确诊。     

高原地区中青年官兵心律失常监测结果的分析

目的 探讨高原低氧低气压环境对驻守官兵心律失常的影响程度.方法 对选定的160例中青年官兵连续记录24h心电图,对不同海拔地区官兵的心电图进行比较.结果 160例官兵中,有141例出现不同程度的心律失常.海拔≥4000m的官兵复合心律失常的发生率大于海拔3000 ～ 3500m,两者比较有统计学差异（p＜0.05）.海拔≥4000m的官兵室性早搏Lown分级≥3级的人数高于海拔3000 ～ 3500m,两者比较有统计学差异（p＜0.05）.结论 高原低氧低气压环境易导致心律失常的发生.海拔越高,心律失常越严重.因此,坚持每天吸氧,科学的训练,加强官兵的耐力及有氧能力的训练,可减少心律失常的发生.     

老年心血管病合并焦虑抑郁症患者心律失常的动态心电图分析

目的 探讨动态心电图监测下,老年心血管病患者伴焦虑抑郁症与心律失常的关系.方法 选取2011-01至2012-08期间我院收治的伴焦虑抑郁症的老年心血管病患者80例作为观察组,以不伴有焦虑抑郁症的老年心血管病患者70例作为对照组,观察动态心电图监测下的心律失常发生情况,阐明焦虑抑郁症与心律失常之间的关系.结果 观察组患者心律失常检出率明显高于对照组,数据分析发现其差异具有统计学意义（P〈0.05）.结论 通过动态心电图对伴焦虑抑郁症老年心血管病患者进行监测,可明显发现心血管病患者其焦虑抑郁症患者与心律失常的发生密切相关,具有广泛的应用前景,值得在临床上推广使用.     

Association between sense of coherence and heart rate variability in healthy subjects

Objectives This report investigates whether there is any association between sense of coherence (SOC), as a coping measure in confronting stressful conditions, and heart rate variability (HRV), as a measure of the cardiac autonomic nervous system during the daily life pattern. Methods Sixteen healthy university students (14 males and 2 females) filled in the validated Japanese version of the SOC-13 questionnaire before being informed about the study protocol. For each participant, we calculated 5-minute HRV indices using logarithmically transformed data on frequency domains for HRV derived by 24-hour Holter monitoring. Frequency domains for HRV recordings were investigated for the 24-hour time periods. Results The correlation coefficient between the SOC scores and the high frequency power of HRV (0.15–0.40) was positively significant during the resting sitting position (r≥0.60, P<0.05). After grouping SOC scores by the median, the high frequency domain of HRV was higher in high SOC subjects for most of the 24-hour time period. Conclusion A higher SOC could modulate the parasympathetic tone of cardiac autonomic activity, especially during the resting sitting position.     

地氟醚对冠心病病人血液动力学及ST段影响的临床研究

目的 受用经气多普勒超声及Ｈｏｌｔｅｒ心电监测仪观察地氟醚对冠心病病人血液动力力学及ＳＴ段的影响，方法 ４０例ＡＳＡⅡ～Ⅲ级择期手术的冠心病病人，随机分为两组，分别吸入地氟醚（Ｉ组）和异氟醚（Ⅱ组）所有病人麻醉前１小时肌肉注射哌替啶，东莨菪碱，局麻下行国脉及颈内静穿刺，用芬太尼，依托咪酯，维库溴铵诱导，２％利多卡因喷喉，插入多普勒气管导管，并与心输出量测定仪连接，用ＯｈｍｅｄａＥｘｃｅｌ８０型全能     

动态心电图评价依帕司他对糖尿病心率变异性影响和疗效分析

目的:应用动态心电图评价依帕司他对糖尿病患者心率变异性的影响,确认依帕司他治疗糖尿病心脏自主神经病变的疗效。方法:收集糖尿病合并心脏自主神经病变患者100例,分为治疗组和对照组,治疗组患者口服依帕司他50 mg,tid,共8周。运用24 h动态心电图检测所有患者在治疗前后心率变异性指标的变化,观察依帕司他治疗糖尿病心脏自主神经病变的疗效。结果:治疗组心率变异性各项指标治疗2个疗程后较治疗前有显著提高,自主神经症状明显好转,与对照组比较有显著意义。结论:依帕司他治疗糖尿病心脏自主神经病变的疗效显著,可改善患者心率变异性。     

妊娠高血压病人心率变异性与血清甲状腺激素异常的关系

目的探讨妊娠高血压病人心率变异性（HRV）与血清甲状腺激素的关系.方法应用Century 3000型闪光卡型动态心电图自动分析系统对60例妊娠高血压疾病病人（观察组）及60名正常妊娠（对照组）HRV 频域及时域进行分析,同时用放免法测定甲状腺激素水平.结果妊娠高血压疾病病人中,血清三碘甲状腺原氨酸（T3）减低（P＜0.05）,而反三碘甲状腺原氨酸（rT3）水平升高（P＜0.01）;HRV指标24 h正常R-R间期标准差（SDNN）、24 h相邻R-R间期差值的均方根（rMSSD）、低频成分（LF）和高频成分（HF）水平降低P＜0.05）,而LF/HF升高（P＜0.05）.结论妊娠高血压疾病病人存在继发性甲状腺代谢紊乱,低T3及高rT3水平可作为评价妊娠高血压疾病病人及预后的指标之一.     

支持向量机在建立冠心病早期诊断模型中的应用

目的 探索支持向量机方法在建立冠心病早期诊断模型中的应用,为冠心病危险因素在早期诊断中的合理应用提供理论依据.方法 首先应用logistic回归分析方法筛选冠心病危险因素,将有统计学意义的危险因素与24 h动态心电图检查结果共同构建支持向量机模型,并应用测试数据集对各模型的诊断能力进行评价.结果 24 h动态心电图检查结果与危险因素共同构建的支持向量机模型较单独应用24 h动态心电图诊断有更好的诊断准确率和灵敏度,特异度较低.对应用不同变量构建的模型进行比较,应用24 h动态心电图,结合年龄、性别、糖尿病、高血压构建的模型诊断效果较好,准确率为70.35%,灵敏度为90.27%,特异度为34.76%.结论 应用支持向量机可以建立合适的冠心病早期诊断模型;结合主要危险因素进行冠心病的早期诊断可以提高诊断准确率.     

The Utility of Holter Monitoring Compared to Loop Recorders in the Evaluation of Syncope and Presyncope

Background: Holter monitoring is frequently used to assess patients with syncope, but rarely provides a diagnosis. Newer loop recorders provide the opportunity for prolonged electrocardiographic monitoring to enhance diagnostic yield. Methods: The results of 232 Holter monitors and 81 loop recordings performed for the investigation of syncope or presyncope were reviewed for indication, patient demographics, and presence and type of symptoms and/or arrhythmias. The results were classified as (1) symptom‐arrhythmia correlation, (2) clinically useful information (group 1 plus those excluding arrhythmic syncope, and those demonstrating asymptomatic serious arrhythmias) and (3) unhelpful (asymptomatic and no serious arrhythmias). Results: Loop recorders provided a symptom‐arrhythmia correlation in 11.1% of patients compared to only 0.4% in the Holter group (P < 0.0001). Clinically useful information was obtained in 54.3% of loop patients compared to 27.6% in the Holter group (P < 0.0001). Technical problems occurred in 0.4% of the Holter patients and in 3.7% of loop patients (P = 0.05). Classification was difficult in seven patients in the Holter group; two experienced symptoms during sinus rhythm but also had a serious asymptomatic arrhythmia, and five patients had 6–10 beats of asymptomatic ventricular tachycardia at a rate < 160 beats/min. Conclusion: Loop recording was well tolerated and superior to Holter monitoring in providing a symptom‐arrhythmia correlation or clinically useful information in patients with syncope and presyncope. An initial approach with a loop‐recording device should be employed in these patients.