24小时动态心电图对不明原因晕厥的诊断意义

目的 分析24h动态心电图在心律失常和心肌缺血引起的心源性晕厥中的临床诊断价值.方法 连续入选2010年2月至2012年10月以晕厥待查为诊断的患者共134例,均行24 h动态心电图及冠状动脉造影或心内电生理检查,详细记录生活日记,准确记录晕厥时间.结果 经冠状动脉造影及心内电生理检查确诊78例,24h动态心电图确诊59例,真阳性42例,真阴性39例,假阳性17例,假阴性36例,敏感度53.85％（42/78）,特异度69.64％（39/56）,阳性预测值71.19％（42/59）,阴性预测值52.00％（39/75）.结论 动态心电图对心律失常和心肌缺血引起的心源性晕厥有重要的临床诊断价值,反复多次检查可提高诊断阳性率.

The clinical value of 24-hour dynamic electrocardiogram for syncope of unknown reason

Objective To analyze the clinical value of 24 h dynamic electrocardiogram （Holter） for cardiogenic syncope caused by arrhythmia and myocardial ischemia.Methods A total of 134 patients from February 2010 to October 2012 diagnosed syncope who received Holter and coronary arteriography （CAG） or electrophysiological examination were enrolled in this study.The daily record and the time of syncope were recorded exactly.Results Seventy-eight patients had final diagnosis by CAG and electrophysiological examination,and 59 patients were diagnosed by Holter.The true positive was 42 cases,the true negative was 39 cases,the false positive was 17 cases and the false negative was 36 cases.Thus,the sensitivity,specificity,positive predictive value and negative predictive value were 53.85% （42/78）,69.64% （39/56）,71.19% （42/59） and 52.00%（39/75）.Conclusions Holter is a very important diagnostic method for cardiogenic syncope caused by arrhythmia and myocardial ischemia.Repeated and multiple examination can improve the diagnostic yield.