【摘要】 目的评价心电远程移动监护系统(RHMS)对患者进行远程实时监测、异常心电活动预警和长程心电活动记录的准确性和可靠性。方法连续选取60例2014年10月至12月山东大学齐鲁医院需要进行心电图或动态心电图检查的患者进行前瞻性研究。所有患者同步行RHMS和动态心电图监测仪记录24 h心电活动。采集RHMS和动态心电监测仪记录的心电图基线漂移发生率、最大值和平均值,分析该系统实时监护预警发送心电图片段图形的可靠率,并与普通静态12导联心电图进行比较;测量同一患者、同时间段各检测方法记录心电图中,各导联(Ⅰ、Ⅱ、Ⅲ、aVR、aVL、aVF、V1、V5)波形的波幅和时限以及ST段偏移程度,比较该系统与普通静态12导联心电图、动态心电图之间的差异,观察心电图图形的准确性。对实时心电预警发送的心电图片段中的异常心电活动进行分类计数,并与同一患者、同时间点的动态心电图进行比较;对该系统长程(≥22 h)心电图记录的异常心电活动进行分类计数,并与同一患者的动态心电图分析结果进行比较。结果60名患者男34例,女26例;年龄16~96岁,平均(58±14.5)岁。RHMS采集的心电图的极限漂移率为5.0%(3/60),平均偏移(0.10±0.64)mm,最大偏移2 mm,与动态心电图比较,差异无统计学意义(均P>0.05)。RHMS心电远程移动监护系统实时预警发送心电图片段的图形可靠率为97.75%(2 820/2885),与普通静态12导联心电图的差异无统计学意义(P>0.05);与相同患者、同时间点、同导联的动态心电图比较,RHMS心电远程移动监护系统采集心电图的各波波幅、时限及ST段偏移程度间的差异均无统计学意义(P均>0.05)。RHMS心电远程移动监护系统预警发送的心电图片段和长程心电图中,各类异常心电活动事件的记录频次,均与同一患者、同时间点的动态心电图间的差异无计学意义(P均>0.05)。结论 RHMS心电远程移动监护系统可较灵敏地发现异常心电活并及时预警、准确记录、迅速发送,为异常心电活动高危人群的实时监测、早期预防、尽早干预提供有效保障,有利于降低心律失常对患者可能造成的危害,在临床工作中具有广泛的应用前景。更多还原

【Abstract】 Objective To evaluate the accuracy and reliability of ECG remote mobile monitoring system in remote dynamic monitoring,early warning of abnormal electrical activity and long-range records.Methods A prospective study was conducted on 60 cases patients needing electrocardiogram(ECG) or dynamic ECG examination continuously selected from Qilu Hospital of Shandong University from October to December 2014. All patients were examined with ECG RHMS and dynamic ECG monitor simultaneously for24 hours. The stability of ECG RHMS dynamically sending ECG records was evaluated by collecting the baseline drift, maximum and average value of ECG and compared with the ordinary static 12-lead electrocardiogram. The waveform amplitude and duration of leads(Ⅰ,Ⅱ,Ⅲ,aVR,aVL,aVF,V1,V5)in ECG detection results of various recording methods were recorded in the same patient and at the same time. The image quality was evaluated by comparing ECG RHMS with ordinary static 12-leadelectrocardiogram and dynamic electrocardiogram. The abnormal electrical activity in real-time ECG fragments automatically sent by ECG RHMS remote mobile monitoring system was counted and classified to compare with dynamic electrocardiogram of the same patient and at the same time. The long range(22h or higher) of ECG RHMS was recorded and classified to compare with the dynamic electrocardiogram of the same patient. Results There were 34 males and 26 females,aged 16-96 years,average(58±14.5) years.According to ECG RHMS monitoring system,the limit of the electrocardiogram drift rate was for 5.0%(3/60),the average deviation for(0.10±0.64) mm and the maximum displacement for 2 mm,with no statistically significant difference compared with dynamic electrocardiogram(P>0.05). The reliability of remote mobile ECG RHMS monitoring system for real-time sending segments of ECG graphics was 97.75%(2 820/2 885),with no statistical significance in comparison with ordinary static 12-lead electrocardiogram(P>0.05). The wave amplitudes,time limits and degrees of ST segment deviation differences collected by remote mobile ECG RHMS monitoring system showed no statistical difference compared with the same patient,the same time points and same lead dynamic electrocardiogram(P>0.05). The records of all kinds of abnormal electrical activity in segments of electrocardiogram and long-range electrocardiogram sent by the remote mobile ECG RHMS monitoring system had no differences in comparison with the dynamic electrocardiograms of same patient at the same time(P>0.05). Conclusion Remote mobile RHMS ECG monitoring system can be more sensitive to find abnormal ECG activity and warn in time to accurately and quickly sending records and hence provide effective security in real-time monitoring,early prevention and early intervention for high-risk persons with abnormal electrical activity,as is beneficial to reduce harm of arrhythmia to patients and is worthy of extensive application in clinical work.更多还原