摘要
背景心律失常是心血管疾病患者常见的临床表现,具有一过性和阵发性的特点。患者易在院外发生心律失常,而传统的心电图设备因难以随时佩戴,常导致无法捕捉到患者心律失常发作时的心电信号。目的探讨院前应用散点图初筛可穿戴单导联远程心电监测心律失常的效果。方法选取2018年9月至2019年9月银川市基层医疗机构就诊的1076例患者,均在有心悸、头晕、胸闷、气短等症状时,在院外佩戴可穿戴单导联远程心电监测设备,采集并实时上传至云端的24 h心电图资料。A组为基层医生依据散点图的诊断,B组和C组为银川市第一人民医院远程心电诊断中心医生分别依据散点图和散点图结合心电图的诊断。分析三组心律失常检出率、检出类型、诊断一致性及符合率,并以C组为金标准,分析A组和B组诊断心律失常的灵敏度、特异度、阳性预测值及阴性预测值。结果(1)A组、B组、C组分别检出14种1301例次、14种1323例次、15种1647例次心律失常,心律失常检出率分别为80.9%、81.2%、87.5%。(2)A组与B组诊断心律失常具有强一致性(Kappa=0.891,95%CI(0.711,1.071),P=0.617),诊断符合率为96.7%;B组与C组诊断心律失常具有强一致性(Kappa=0.759,95%CI(0.489,1.029),P<0.001),诊断符合率为93.6%;A组与C组诊断心律失常具有较强的一致性(Kappa=0.692,95%CI(0.392,0.992),P<0.001),诊断符合率为91.7%。(3)A组诊断心律失常的灵敏度为91.5%、特异度为93.3%、阳性预测值为99.0%、阴性预测值为61.2%,B组诊断心律失常的灵敏度为92.8%、特异度为99.3%,阳性预测值为99.9%、阴性预测值为66.3%。结论在院前应用散点图初筛可穿戴单导联远程心电监测心律失常,可实现心律失常诊疗关口前移,并以此建立起由社区居民、基层全科医生和远程心电诊断中心医生共同参与的心律失常防治网。
Background Arrhythmia is a common cardiovascular disease,which has a range of transient or paroxysmal conditions.Arrhythmia easily occurs outside of the hospital,but signals of its onset often could not be captured by traditional ECG devices since they can not be worn at any time.Objective To assess the effect of applying scatter diagram in prehospital screening for arrhythmia via analyzing patients'data monitored by the single lead,wearable remote ECG monitoring system.Methods Participants(n=1076)were primary care patients who were selected from Yinchuan from September 2018 to September 2019.All of them used single lead,wearable remote ECG monitoring system to monitor cardiac rhythms prehospitally when they had palpitation,dizziness,chest tightness,shortness of breath and other symptoms,and real-timely uploaded 24-hour ambulatory ECG data to be used for screen for arrhythmia by different approaches:approach A(diagnosis made using scatter diagram analysis by primary care physicians),approach B(diagnosis made using scatter diagram analysis by physicians from Remote ECG Center,the First People's Hospital of Yinchuan),and approach C(diagnosis made using scatter diagram analysis and ECG analysis by physicians from Remote ECG Center,the First People's Hospital of Yinchuan).Prevalence and types of arrhythmia detected by these approaches and diagnostic coincidence rate of these approaches were analyzed.The sensitivity,specificity,positive and negative predictive values of approaches A and B were assessed with those of approach C as the gold standard.Results(1)The frequencies of arrhythmias detected by approaches A,B and C were 1301,1323,and 1647,respectively.The types of arrhythmias detected by approaches A,B and C were 14,14,and 15,respectively.And the prevalence of arrhythmias detected by approaches A,B and C were 80.9%,81.2%and 87.5%,respectively.(2)The diagnoses made by approaches A and B were highly consistent(Kappa=0.891,95%CI(0.711,1.071),P=0.617),and the diagnostic coincidence rate was 96.7%.The diagnoses made by approaches B and C were highly consistent(Kappa=0.759,95%CI(0.489,1.029),P<0.001),and the diagnostic coincidence rate was 93.6%.The diagnoses made by approach A were relatively consistent with those by approach C(Kappa=0.692,95%CI(0.392,0.992),P<0.001),and the diagnostic coincidence rate was 91.7%.(3)The sensitivity,specificity,positive and negative predictive values of approach A in diagnosing arrhythmia were 91.5%,93.3%,99.0%and 61.2%,and those of approach B were 92.8%,99.3%,99.9%and 66.3%.Conclusion Using scatter diagram in prehospital screening for arrhythmia through analyzing the monitoring results of single lead,wearable remote ECG monitoring system will contribute to the development of arrhythmia diagnosis and treatment in primary care,and the establishment of an arrhythmia prevention and treatment network with the participation of residents,primary care physicians and remote ECG center physicians.
作者
余新艳
赵瑞琴
彭军
张晓娟
杨建云
张海澄
YU Xinyan;ZHAO Ruiqin;PENG Jun;ZHANG Xiaojuan;YANG Jianyun;ZHANG Haicheng(Health Management(Physical Examination)Center,the First People's Hospital of Yinchuan,Yinchuan 750001,China;Electrophysiological Center,the First People's Hospital of Yinchuan,Yinchuan 750001,China;Department of Electrocardiography,Children's Hospital Affiliated to Xi'an Jiaotong University,Xi'an 710003,China;Department of Cardiology,Peking University People's Hospital,Beijing 100044,China)
出处
《中国全科医学》
CAS
北大核心
2022年第2期159-165,共7页
Chinese General Practice
基金
宁夏回族自治区科技惠民专项项目(2018CMG03015)。
关键词
心律失常
心血管疾病
散点图
可穿戴单导联远程心电监测
互联网+分级诊疗
Arrhythmia
Cardiovascular disease
Scatter plot
Wearable single lead remote ECG monitoring
Internet plus grading treatment
作者简介
通信作者:张海澄,主任医师,E-mail:haichengzhang@bjmu.edu.cn。
