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心电图\超声心动图对冠心病诊断价值再评价

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  【摘要】目的探讨临床拟诊冠心病患者心电图、心脏超声心动图改变与冠状动脉造影结果的关系及它们在冠心病诊断中的价值。方法 选择98例可疑冠心病患者进行常规心电图检查,用心脏超声心动图检测患者的心功能,并与这些患者的冠脉造影结果进行对比分析。结果 常规心电图诊断冠心病的敏感度为74.6%(59/79),特异度为52.6%(10/19),心电图随着冠状动脉病变支数增加而检出冠心病的阳性率增高。心脏超声心动图诊断冠心病的48.1%(38/79) 特异性为68.4%(13/19)。结论 ECG仍是简便和较为敏感的诊断方法,超声心动图诊断冠心病敏感性较低而特异性较高,二者结合有助于提高对冠心病的诊断率,故据心电图、超声心动图改变对诊断冠心病有一定价值。
  【关键词】心电图;超声心动图;冠脉造影;冠心病
  
  ECG, Echocardiography re-evaluation of Diagnostic value of Coronary Heart Disease
  QIN Jide
  Shangqiu City of Cardiology, First People's Hospital, Shangqiu 476000 China
  
  【Abstract】Objective:To investigate the clinical electrocardiogram in patients with coronary heart disease to be patient, cardiac echocardiography and coronary ang iog -raphy to change the relationship and in their diagnosis of coronary artery disease. Methods: 98 patients with suspected coronary artery disease patients with normal ECG, cardiac echocardiography with the patient's cardiac function, and with the results of coronary angiography in these patients were analyzed.Results:The sens- itivity of conventional ECG diagnosis of coronary heart disease was 74.6% (59/79), specificity was 52.6% (10/19), electrocardiogram with coronary artery increase in the number of positive rate of detection of coronary heart disease increase ed. Echocardio graphic diagnosis of heart of coronary artery disease 48.1% (38/79) and specificity of 68.4% (13/19). Conclusions: ECG is still simple and more sensitive diagnostic methods, the sensitivity of echocardiographic diagnosis of coronary heart disease lower high specificity, combination of both contribute to the diagnosis of coronary heart disease rate, so far as ECG, echocardiography change diagnosis of coronary heart disease have a certain value.
  【Keywords】ECG;Echocardiography;Coronary Angiography; Coronary Artery Disease
  
  心电图(ECG)是将测量电极放置在人体表面的一定部位记录出来的心脏电变化曲线。ECG不仅可诊断心肌梗死,还能判断梗死相关动脉,对急诊经皮冠脉介入治疗有重要指导作用[1]。超声心动图(echocardiography)已广泛用于冠心病的诊断及疗效评估,为临床研究冠心病提供了更直观、更量化的诊断依据。它们都是常用的冠心病无创性辅助检查方法。近年来,心脏病人诊断、治疗的模式已经发生了深刻变化,广范开展的冠状动脉造影(CAG)为我们直观地展现冠脉病变的位置和程度,CAG是确诊冠心病的“金标准”,但是有创、价格昂贵。本研究拟将冠脉造影所获得的临床证据与心电图、超生心电图有机结合,以丰富心电图、超声心动图对冠心病诊断的临床应用价值。
  
  1资料与方法
  
  1.1一般资料回顾分析我院2009年5月~2009年11月拟诊冠心病患者98例,均已行CAG,其中男 63例,女35例,年龄36~82岁,平均60.5岁,包括急性心肌梗死10例,陈旧性心肌梗死8例,不稳定心绞痛14例,合并糖尿病28 例,合并高血压病49例,其中合并高脂血症20例、吸烟者32例。
  1.2方法以冠脉造影为金标准,回顾性分析拟诊冠心病患者的心电图、超声心动图表现,评价它们对冠心病的临床诊断价值。所有患者均常规检查12导联心电图,部分患者行心电图负荷试验;所有患者均常规检查超声心动图;冠脉造影检查采用Judkins法,行多体位左、右冠状动脉造影,部分患者同时进行介入治疗