24 h动态心电图检查在起搏器植入心律失常诊断中的应用价值

目的探究24 h动态心电图检查在起搏器植入心律失常诊断中的应用价值。方法回顾性分析2013年8月至2019年7月中国人民解放军联勤保障部队第九〇一医院收治的78例起搏器植入术治疗患者,分别采用12导联心电图(列为A组)、24 h动态心电图(列为B组)进行监测。比较2组方案的起搏器功能异常率、心律失常检出率、心率变异性(HRV)时域指标变化及术后心肌缺血检出情况。结果B组起搏器功能异常率、心律失常检出率分别为47.4%、80.8%,均分别高于A组的7.7%、80.8%,差异有统计学意义(P均<0.001)。B组24 h内正常RR间期标准差(SDNN)、全程每5 min时段RR间期均值标准差(SDANN)及24 h内相邻正常RR间期之差均方根值(RMSDD)分别为(137.25±15.98)、(132.92±15.43)、(39.25±11.36)ms,分别高于A组的(91.39±14.36)、(87.15±17.61)、(21.65±9.25)ms,差异有统计学意义(P<0.001)。B组术后心肌缺血ST-T改变检出率为26.9%,高于A组的5.1%,差异有统计学意义(P<0.001)。结论起搏器植入术后应用24 h动态心电图监测可进一步提高起搏器功能异常、心律失常检出率,其HRV敏感性较高,且有助于提高术后心肌缺血检出率。

Value of 24 h dynamic electrocardiogram in the diagnosis of pacemaker implantation arrhythmia

Objective To explore the application value of 24 h dynamic electrocardiogram in the diagnosis of pacemaker implantation arrhythmia.Methods From August 2013 to July 2019,78 patients treated with pacemaker implantation in the 901st Hospital of the Chinese People's Liberation Army Joint Logistic Support Force were retrospectively selected,adopt the 12-lead electrocardiogram(A group),24 h dynamic electrocardiogram(B group)monitoring.The pacemaker function obstacle detection,arrhythmia,heart rate variability(HRV)and postoperative myocardial ischemia time domain index change detection of the two groups were compared.Results The abnormal rate of pacemaker function and the detection rate of arrhythmia in group B were 47.4%and 80.8%,respectively,which were higher than those in group A(7.7%and 80.8%),the differences were statistically significant(P<0.001).SDNN,SDANN and RMSDD in group B were(137.25±15.98),(132.92±15.43)and(39.25±11.36)ms,respectively,which were higher than those in group A(91.39±14.36),(87.15±17.61)and(21.65±9.25)ms],the differences were statistically significant(P<0.001).The detection rate of myocardial ischemic ST-T change after operation in group B was 26.9%,higher than that in group A(5.1%),the difference was statistically significant(P<0.001).Conclusion The detection rate of pacemaker dysfunction and arrhythmia can be further improved by 24 h dynamic electrocardiogram monitoring after pacemaker implantation,and the HRV sensitivity is high,which is helpful to improve the detection rate of postoperative myocardial ischemia.