仰卧位与半卧位及直立位12导联心电图：体位改变会影响缺血性心电图解读吗？
Supine vs semirecumbent and upright 12-lead electrocardiogram: does change in body position alter the electrocardiographic interpretation for ischemia?
作者信息
Baevsky Robert H, Haber Marc D, Blank Fidela S, Smithline Howard
机构信息
Department of Emergency Medicine, Tufts University School of Medicine, Baystate Medical Center, Springfield, MA 01199, USA.
出版信息
Am J Emerg Med. 2007 Sep;25(7):753-6. doi: 10.1016/j.ajem.2006.12.005.
OBJECTIVE
The goal of this study was to determine if a change in body position alters the 12-lead electrocardiographic (ECG) interpretation for ischemia and ST-segment elevation, the latter having direct implications for initial patient management in the emergency department.
METHODS
Twelve-lead ECGs were sequentially obtained from a convenience sample of healthy adult volunteers in 3 positions (supine, 0 degrees; inclined, 45 degrees; and upright, 90 degrees). The tracings were randomized, blinded, and then independently read by 2 trained emergency medicine physicians who also assessed for the presence of ischemia and ST-segment elevation myocardial infarction.
RESULTS
Seventy-five subjects were enrolled, with 7 (9%; 95% confidence interval [CI], 4-18) having ischemia on the supine ECG, 9 (12%; 95% CI, 6-22) on the incline, and 9 on the upright tracings. ST-segment elevation myocardial infarction pattern was present on 2 (3%; 95% CI, 0-9) supine, 2 inclined, and 2 upright ECGs.
CONCLUSIONS
Changes in body position result in some ischemic variations of the 12-lead ECG.
目的
本研究的目的是确定体位改变是否会改变12导联心电图（ECG）对缺血和ST段抬高的解读，后者对急诊科患者的初始管理有直接影响。
方法
从健康成年志愿者的便利样本中按顺序获取12导联心电图，共3个体位（仰卧位，0度；倾斜位，45度；直立位，90度）。心电图记录随机化、设盲，然后由2名训练有素的急诊医学医生独立阅读，他们还评估是否存在缺血和ST段抬高型心肌梗死。
结果
共纳入75名受试者，仰卧位心电图有7例（9%；95%置信区间[CI]，4 - 18）存在缺血，倾斜位有9例（12%；95% CI，6 - 22），直立位有9例。仰卧位、倾斜位和直立位心电图各有2例（3%；95% CI，0 - 9）出现ST段抬高型心肌梗死图形。
结论
体位改变会导致12导联心电图出现一些缺血性变化。
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