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1、华 中 科 技 大 学 硕 士 学 位 论 文分 类 号 学号 学校代码 10487 密级 研究冠心病患者心功能严重程度与心电图指标之间的关系 目的：通过分析冠心病患者心功能严重程度与心电图指标之间的关系，为冠心病的临床诊断提供便捷的方法。方法：所有研究对象均来源于2011年10月到2014年10月间在医院因冠心病住院或体检的人。观察组为因冠心病心功能不全在心内科住院的患者196人(男性87名，女性109名)，平均年龄(70.34士8.95)岁，所有这些患者都符合WHO关于冠心病的诊断标准。健康对照组为35名既往无特殊病史并被我院体检科证实为健康的人。根据心脏多普勒超声检查结果，将196名患者
2、分为两组。其中A组即EF值（左室射血分数）50%的112人；B组则为EF值50%的84人。A组患者根据NYHA分级，分成A1、A2、A3、A4四个亚组。其中A1组25例患者心功能为I级，A2组29例患者心功能为II级，A3组32例患者心功能为III级，A4组26例患者心功能为IV级。B组患者根据NYHA分级，同样分成四个亚组，B1组21例患者心功能为I级，B2组24例患者心功能为II级，B3组20例患者心功能为III级，B4组19例患者心功能为IV级。常规检测血常规、肝、肾功能、血糖、血脂、脑钠肽、C-反应蛋白，彩色多普勒超声心动图，利用12导联心电图记录患者P波离散度（Pd）、QT间期离散度
3、（QTd）、T峰-T末（Tpe）数值，通过分析患者心功能和Pd, QTd, TPe数值，来观察他们之间的关系。用Epidata3.1技术在网络上建立数据库，将所有信息进行录入并校对，再利用SPSS20.0软件对数据进行分析。使用t检验和方差分析对资料进行单因素分析，建立多因素logistic回归模型对患者心功能和Pd, QTd, TPe数值进行分析。p0.05差异有统计学意义。结果：研究结果表明，EF值50%组和EF值50%组患者，随着心脏功能的恶化，患者的左房内径、左室舒张期末内径、血肌酐、脑钠肽数值就会越来越高，他们之间的差异有统计学意义（P0.05)。两组患者P波离散度、QT间期离散度、
4、T峰-T末（Tpe）在每个亚组间的比较发现存在差异，且差异有统计学意义（P0.05)。结论：随着冠心病患者的心功能不断恶化，Pd有增加趋势，其心房纤颤发生的可能性增加；随着冠心病患者的心功能不断恶化，QT和QTd呈现增加趋势，其恶性心律失常发生的可能性增加；随着冠心病患者的心功能不断恶化，Tpe呈现增加趋势，其恶性心律失常发生的可能性增加。关键词：冠心病患者；心功能；心电图指标第 45 页 共 45 页Objective: To explore the relationship between the Severity of Cardiac function and Electrocardio
5、gram indicators in patients with coronary heart disease, as well as provide convenient methods for clinical diagnosis of coronary heart disease.Method: All the samples were collected in Wuhan Commercial Staff Hospital from October of 2011 to October of 2014. 196 Patients（87 male and 109 female with
6、an average of 70.34士8.95）with cardiac functional insufficiency were in Observation group, and 35 persons who had no previous medical history and were identified as healthy by Medical Section were supposed to be the healthy controls.196 patients were divided into Group A and Group B according to the
7、results of Doppler echocardiography. 112 patents(Left ventricurlar ejection fraction less than 50%) were in Group A and 84 patients(Left ventricurlar ejection fraction more than 50%) were in Group B. Patients in group A were divided into four subgroups according to NYHA classification. 25 cases were
8、 in Group A1 with cardiac function grade I, 25 in Group A2 with cardiac function grade II, 32 in Group A3 with cardiac function grade III and 26 in Group A4 with cardiac function grade IV. Patients in Group B were also divided into four subgroups according to NYHA classification among which 21 patie
9、nts in Group B1 with cardiac function grade I, 24 patients in Group B2 with cardiac function grade II,20 patients in Group B3 with cardiac function grade III and 19 patients in Group B4 with cardiac function grade IV.Routine testing included routine blood test, kidney and liver function, blood sugar
10、, blood-lipid, brain natriuretic peptide, C-reaction protein, color doppler echocardiography. Record the data of P wave dispersion degree(Pd), dispersion of QT interval(QTd) and T peak-T end (Tpe) by using 12-lead electrocardiogram and try to find their relationship between the cardiac function and
11、Pd, QTd, TPe of patients. Database was established by using Epidata3.1 and data entry was done. Multiple logistic regression analysis was used to find out the relationship between the cardiac function and Pd, QTd, TPe of patients by using SPSS.Results: Research shows that the left atrial diameter, l
12、eft ventricular enddiastole, serum creatinine and brain natriuretic peptide were getting higher with the deteriorating cardiac function. The difference was statistically significant between them（P0.05).The differences of Pd, QTd, TPe between two groups were found and statistically significant (P 0.0
13、5).Conclusion:With deteriorating cardiac function of coronary heart disease, there is a increasing tendency of Pd and more possibility of atrial fibrillation. Beyond that，QT , and QTd are increasing, and more likelihood of malignant arrhythmias is predicted. Futhermore, Tpe show increasing trend, an
14、d the patients prognosis is poorer.Key words: Coronary Heart Disease; Heart Function; Pulmonary Arterial Pressure; Electrophysiology; ECG Indices. 英文缩略词及中文对照英文缩写 英文全称 中文全称Pd P wave dispersion P波离散度QTd QT interval dispersion QT离散度Tpe T peak-T end T峰-T末AF atrial fibrillation 心房纤颤ECG electrocardiograms 心电图CHF chronic heart failure 慢性心力衰竭CAD coronary artery disease 冠心病TDR transmural dispersionofreplorization跨室壁的复极离散度AMI Acute myocardial infarction 急性心肌梗死CHD coronary atherosclerosis heart disease 冠状动脉粥硬化性心脏病HRV Heart rate variability 心率变异性LVEF ventricular ejection fraction 左心室射血分数BNP br
