12导联动态心电图对冠心病的诊断价值

目的:评价12导联动态心电图(12导Holter)对冠心病(CHD)的诊断价值.方法:选择47例拟诊为冠心病的心内科住院患者.同期内(间隔≤1周)分别接受冠状动脉造影(CAG)﹑12导Holter及二维多谱勒心脏超声心动图(2DE)检查,以CAG作为对照,以心超结果作为参考对12导HolterST段进行分析.结果:(1)三种方法检出率分别为90.6%,64.7%,47.3% .(2) 12导Holter诊断冠心病的敏感性﹑特异性分别为71.43%,60%.对单支病变组﹑多支病变组检出率分别为68.96%,76.92%.单支组与多支组检出率比较差异无显著性(p>0.05);心超诊断冠心病的敏感性﹑特异性分别为52.38%,100%;对单支病变组﹑多支病变组检出率分别为31.03%,100% ,单支组与多支组检出率比较有统计学意义(p<0.05).(3)12导Holter检测结果还表明冠脉狭窄程度越重ST段下移程度越大,持续时间越长,心律失常检出率越高,且心律失常频度及复杂性越明显. 结论:12导Holter对冠心病的诊断具较高的敏感性,且无创、费用低,可作为冠心病诊断的基本方法.

THE UALUE OF 12-LEAD HOLTER IN THE DIAGNOSIS OF CORONARY HEART DISEASE

Objective: To evaluate the diagnostic value of 12-lead Holter in the coronary heart disease(CHD).Methods:47 inpatients from cardiovascular ward who had been diagnosed as susceptible CAD were selected.They were examined by CAG,12-lead Holter and 2-dimension echocardiography .The duration of the three examinations was less than one week .Based on coronary angiography ,the results of and the ST-segment data of 12-lead Horter were analysed .Results:(1)The positive rate of the three methods(CAG, 12-lead Holter, echocardiography ) in the diagnosis of CAD were 90.6% ,64.7% and 47.3% respectively .(2)The sensitivity and specificity of 12-lead Holter in the diagnosis of CAD were 71.43% and 60% respectively .The positive rate of 12-lead Holte in singe-vessle CAD group and multi-vessle CAD group were 68.96% and 76.92% respectively .There was no significant difference between the two groups (p>0.05). The sensitivity and specificity of echocardiography in the diagnosis of CAD were 52.38% and 100% respectively . The positive rate of echocardiography in singe-vessle CAD group and multi-vessle CAD group were31.03% and 100% respectively .There were significant difference between singe-vessle CAD group and multi-vessle CAD group(p<0.05) .(3)The results of 12-lead Holter also show that the more serious the degree of the coronary stenosis was, the greater the range of ST-segment depression was , the longer the ST-segment depression continued ,the higher the positive rate of arrhythmia was and the more obvious the frequency and complexity of the arrhythmia was .Conclusion:The sensitivity of 12-lead Holter in the diagnosis of CAD is higher, the cost is low and it is also an effective non-invasive method, so 12-lead Holter can be a basic method in the diagnosis of CAD in the clinical practice .