常规心电图与动态心电图联合应用对儿童病毒性心肌炎的诊断价值

目的探讨心电图与动态心电图联合应用对儿童病毒性心肌炎的诊断价值。 方法回顾性分析本院2012年6月至2015年6月125例病毒性心肌炎患儿的临床资料，所有患儿均检测心肌酶、心肌肌钙蛋白等指标和行常规心电图检测，并联合动态心电图分析系统，连续佩带记录器24 h。 结果入组病毒性心肌炎患儿临床表现复杂多样，其中首发心血管症状者52例（占41.6%），首发消化道症状者22例（占17.6%），首发呼吸道症状者36例（占28.8%）。常规心电图检出各种心律失常98例共147种，动态心电图检查阳各种心律失常110例共199种，联合检测各种心律失常121例共207种，心电图与动态心电图联合检测心律失常种类和例数均显著高于常规心电图与动态心电图单独检查（χ²= 3.146，P = 0.039）。心肌酶和心肌肌钙蛋白、常规心电图、动态心电图及联合检测病毒性心肌炎患儿心律失常阳性率分别为63.2%、78.4%、88%和96.8%，心电图与动态心电图联合检测阳性率显著高于其他几种方法，差异具有统计学意义（χ²= 4.081，P = 0.023）。入组患者心律失常发病种类前5位分别是房性早搏、室性早搏、ST段改变、Ⅰ度房室传导阻滞和QRS低电压。 结论常规心电图是临床常用的检测手段，联合动态心电图检测综合分析可提高心律失常的诊断率，对治疗和判断预后具有积极的指导意义。

Diagnosis value of combined application of conventional electrocardiogram and dynamic electrocardiogram in children with viral myocarditis

ObjectiveTo investigate the diagnosis value of combined application of conventional electrocardiogram and dynamic electrocardiogram in children with viral myocarditis. MethodsTotal of 125 cases with viral myocarditis in our hospital from June 2012 to June 2015 were selected. All of the children were detected with myocardial enzymes, cardiac troponin and other indicators, also conventional ECG detection combined with three channels of the dynamic electrocardiogram analysis system were applied, wearing continuously for 24 h. ResultsThe clinical manifestations of viral myocarditis were complicated and varied, among which, 52 cases (41.6%) presented first cardiovascular symptoms, 22 cases (17.6%) with digestive tract symptoms, 36 cases (28.8%) with respiratory symptoms. There were 147 kinds of (among 98 cases) arrhythmia were detected by routine ECG, 199 kinds (among 110 patients) were detected by dynamic electrocardiogram examination, 207 kinds (among 121 cases) of arrhythmia. The cases detceted by conventional ECG or dynamic ECG were all significantly less than those of conventional ECG combined with dynamic ECG (χ²= 3.146, P = 0.039). The positive rates of viral myocarditis in the patients were 63.2%, 78.4%, 88% and 96.8%, respectively, detected by myocardial enzymes and myocardial troponin conventional, ECG, dynamic ECG, conventional ECG and combined with dynamic ECG detection. The positive rates detected by combined ECG and dynamic ECG was significantly higher than those of other methods, with significant difference (χ²= 4.081, P = 0.023). The top five of arrhythmia symptoms in the 125 patients were real beats, room of beats, ST segment change, first-degree atrioventricular block and QRS low voltage. ConclusionsConventional ECG is a commonly used detection method, the combination with dynamic ECG could improve the diagnosis rate of arrhythmia, with positive guidance for the treatment and prognosis of patients.