摘要
目的分析急性心肌梗死伴阵发性房颤与P波离散度之间的关系,为临床提供检测依据。方法从2014年8月至2017年8月期间本院心内科接收、检查并诊治的急性心肌梗死伴阵发性房颤患者中随机性抽取240例,设为心肌梗死伴房颤组;选取240例急性心肌梗死无阵发性房颤患者,设为心肌梗死无房颤组;240例健康体检者,设为对照组。3组分别行心电图检查,比较P波最小时间(Pmin)、P波最大时间(Pmax)、P波离散度(Pd)、左室射血分数(left ventricular ejection fraction,LVEF)。以Pmax≥100 ms和Pd≥40 ms为阳性标准,同时将720例研究对象根据检查结果分为:Pmax≥100 ms组(A组)、Pd≥40 ms(B组)、Pmax≥100 ms且Pd≥40 ms组(C组),利用ROC曲线计算并比较3组敏感度、特异性、阳性预测值。结果 3组P波最小时间(Pmin)比较,无显著差异(P> 0.05);心肌梗死伴房颤组患者P波最大时间(Pmax)为(129.57±9.89) ms,P波离散度(Pd)为(52.04±3.26),LVEF值为(44.17±5.04)%,与心肌梗死无房颤组相比差异有统计学意义(P <0.05)。A、B、C3组的敏感度相比较无显著差异(P> 0.05);B组的特异性为87.55%、阳性检出率为91.47%,明显高于A组;C组的特异性为89.13%,阳性检出率为95.41%,明显高于A、B组(P <0.05)。结论 P波离散度与P波最大时限可预测急性心肌梗死患者是否伴阵发性房颤,二者联合预测可提高预测的特异性及阳性预测值,有效辅助诊断急性心肌梗死并发症,可供临床诊断提供参考。
Objective To provide reference for clinical diagnosis by analyzing the relationship between acute myocardial infarction （AMI） with paroxysmal atrial fibrillation （PAF） and P-wave dispersion. Methods 240 cases of AMI with PAF were selected from patients who received examinations and treatments in the Department of Cardiology between August 2014 and August 2017 and were taken as myocardial infarction（MI） with atrial fibrillation（AF） group. Meanwhile 240 cases of patients having AMI without PAF were collected as MI without AF group. Furthermore, 240 healthy people were taken as the control group. The three groups were examined by ECG to compare minimum P-wave duration （P min）, maximum P-wave duration （P max）, P-wave dispersion （Pd） and left ventricular ejection fraction（LVEF）. Taking Pmax≥ 100 ms and Pd ≥ 40 ms as positive criteria, 720 cases were divided into three groups： group A with Pmax≥ 100ms, group B with Pd ≥ 40ms, group C with Pmax ≥100ms and Pd ≥40m. The sensitivity, specificity and positive predictive value of the three groups were calculated and compared by ROC curve. Results There was no significant difference in P wave minimum time （P min） and sensitivity among the three groups （P 〉 0.05）. Compared with MI without AF group,P wave maximum time （P max）, P wave dispersion （Pd） and LVEF in MI with AF group was （129.57±9.89） ms, （52.04±3.26） and （44.17±5.04）%, respectively. The difference between these two groups were statistically significant（P 〉 0.05）. The specificity of group B was 87.55% and the positive rate was 91.47%, which were significantly higher than those of group A. The specificity of group C was 89.13% and the positive rate was 95.41%,which were significantly higher than those of Pmax ≥ 100 ms and Pd ≥ 40 ms （P 〈 0.05）.Conclusion P wave dispersion and P max can be used to predict acute myocardial infarction in paroxysmal atrial fibrillation, and these two indices can be combined to improve the specificity and positive predictive value, which can offer references for clinical diagnosis and effectively assist in the diagnosis of the complications of acute myocardial infarction.
作者
高洁
王新康
GAO Jie;WANG Xin-kang(Department of Electrocardiogram,Fujian Provincial Hospital,Fuzhou 350001,China)
出处
《创伤与急诊电子杂志》
2018年第2期97-100,共4页
Journal of Trauma and Emergency(Electronic Version)
关键词
急性心肌梗死
阵发性房颤
P波离散度
Acute myocardial infarction
Paroxysmal atrial fibrillation
P wave dispersion
