老年人左心衰竭急性发作期和稳定期动态心电图分析

摘要

Objective:To analyze the characteristics of dynamic electrocardiogram in acute exacerbation and stable phase of elderly left heart failure patients.Method:The clinical data of 115 elderly left heart failure patients with acute exacerbation in our hospital from September 2012 to November 2014 were retrospectively analyzed.They were given 24 hours dynamic electrocardiogram monitoring retrospectively when they were in acute exacerbation and stable phase.The characteristics of 24 hours dynamic electrocardiogram monitoring of the two periods were compared.Result:The induced factors of left heart failure of acute phase included infection(50.4%),acute myocardial infarction(20.9%),rapid arrhythmia(9.6%),blood pressure caused by emotional(7.0%),infusion too much too fast(6.1%),anemia(3.5%) and drug poisoning(2.6%).The heart rate,premature beat,tachycardia,atrial fibrillation and flutter,ST-T ischemic changes and PtfV1 of the two periods were different,the differences were statistically significant(P<0.01).The incidence rate of atrioventricular block in the acute exacerbation was lower than that in the stable phase,the difference was statistically significant(P<0.05).The incidence rates of a variety of complications in the acute exacerbation were higher than those in the stable phase,the differences were statistically significant(P<0.01).Conclusion:Left heart failure of acute exacerbation is easy to produce a variety of arrhythmia and electrocardiogram changes.So high attention shall be paid to the observation and control of the left heart failure of acute exacerbation.The observation and management of arrhythmia and multiple complications shall be strengthened.%目的：对比分析老年人左心衰竭急性发作期和稳定期的动态心电图特点。方法：回顾性分析2012年9月-2014年11月本院收治的115例已确诊为左心衰竭急性发作期老年患者的临床资料，均行24 h动态心电图监测，稳定后再行24 h动态心电图监测，对比急性发作期与稳定期的动态心电图特点。结果：左心衰竭急性发作期的诱发因素包括感染（50.4%）、急性心肌梗死（20.9%）、快速型心律失常（9.6%）、情绪激动致血压升高（7.0%）、输液过多过快（6.1%）、贫血（3.5%）、药物中毒（2.6%）。左心衰竭急性发作期与稳定期在心率、早搏、心动过速、房颤和房扑、ST-T缺血性改变、PtfV1方面比较，差异有统计学意义（P<0.01）；左心衰竭急性发作期的房室传导阻滞发生率低于稳定期，比较差异有统计学意义（P<0.05）；左心衰竭急性发作期多种并发症发生率均明显高于稳定期，比较差异均有统计学意义（P<0.01）。结论：左心衰竭急性期极易产生多种心律失常和心电图改变，应当高度重视左心衰竭急性发作期的观察和控制，加强对心律失常和多种并发症的观察和处理。