Page 35 - 中国全科医学2022-01

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3.Department of Electrocardiography，Children's Hospital Affiliated to Xi'an Jiaotong University，Xi'an 710003，China
4.Department of Cardiology，Peking University People's Hospital，Beijing 100044，China
*
Corresponding author：ZHANG Haicheng，Chief physician；E-mail：haichengzhang@bjmu.edu.cn
【Abstract】 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=1 076）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 1 301，1 323，and
1 647，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.
【Key words】 Arrhythmia；Cardiovascular disease；Scatter plot；Wearable single lead remote ECG monitoring；
Internet plus grading treatment

心律失常是心血管疾病常见的临床表现，具体表现
关于本研究您可以了解：
为心悸、头晕、胸闷、心绞痛等症状，且部分患者会因
（1）本文着重于临床实际应用，解决了基层医
疾病进展出现晕厥、猝死。但多数患者为一过性或阵发
疗机构在心血管疾病患者筛查和管理中的痛点，并且
性心律失常，并常在院外发生，患者就诊时不适症状已 本研究探索出了适用于基层医疗机构的筛查心律失常
消失 ［1-2］ ，导致临床较难捕捉到发作时的心电信号进而
的适宜的检查设备和诊断技术。（2）散点图与心电
贻误诊断，可能是心脏猝死的原因之一。研究证实，在
图结合应用可提升基层医疗机构对心血管疾病的防控
院前应用可穿戴单导联远程心电设备，不但可提高心律 能力，今后可以在基层医疗机构广泛应用推广。（3）
失常的检出率，还能准确区分心律失常类型 ［3-7］ 。
但是，本研究未对检查符合心电图危急值的患者救治
散点图是连续心电活动的空间轨迹截面图，其采用
进行分析，也未对患者的临床病史及具体症状进行统
非线性混沌的方法学，根据不同 RR 间期序列关系形成
计，需要在今后进一步研究。
特征性图形。分析散点图所代表的心律性质，不但对于
长时程大样本数据的分析有重要意义，而且可使心律失 点图初步诊断和远程心电诊断中心医生确诊的“互联网
常的表现“图像化”、“可视化”，诊断“简单化” ［8］ 。 + 分级诊疗”模式。但目前国内相关研究报道较少。本
因此将其应用在院前可穿戴单导联远程心电监测中，不 研究通过分析基层医生应用散点图和远程心电诊断中心
但可解决传统心电检查设备不能随时随地采集患者心律 医生分别应用散点图和散点图结合心电图对患者在院外
失常发作时心电信号的难题，还可实现基层医生应用散 佩戴可穿戴单导联远程心电监测设备采集的 24 h 动态