评估蛛网膜下腔出血患者的心电图 T 波。

Assessment of the ECG T-Wave in Patients With Subarachnoid Hemorrhage.

机构信息

Department of Anesthesiology, School of Medicine, Dokkyo Medical University, Tochigi, Japan.

出版信息

J Neurosurg Anesthesiol. 2021 Jan;33(1):58-64. doi: 10.1097/ANA.0000000000000624.

DOI:10.1097/ANA.0000000000000624

PMID:31290770

Abstract

BACKGROUND

Prolongation of the interval from the peak to the end of the T wave (Tp-Te) on a 12-lead electrocardiogram (ECG) is associated with ventricular arrhythmias. The aim of this study was to clarify associations between Tp-Te, Tp-Te/QT, and Tp-Te/rate-corrected QT (QTc) with clinical severity of subarachnoid hemorrhage (SAH) and clinical outcomes.

METHODS

This retrospective study included 222 patients with acute SAH (group S) and 306 patients with unruptured cerebral aneurysms (group U). Tp-Te, Tp-Te/QT, and Tp-Te/QTc were manually measured in standard 12-lead ECG recordings on admission and comparisons made between patients in groups S and U. The relationships of these ECG parameters with Hunt and Hess grade and Glasgow outcome scale were analyzed using multiple logistic regression analysis after adjustment for confounding factors.

RESULTS

Tp-Te, Tp-Te/QT, and Tp-Te/QTc were significantly greater in group S than in group U (group S: 109±30, 0.26±0.07, and 0.24±0.06 ms; group U: 84±12, 0.22±0.03, and 0.21±0.03 ms, respectively; P < 0.0001). In addition, in the multiple logistic regression analyses these variables were positively correlated with the Hunt and Hess grade (Tp-Te odds ratio [95% confidence interval], 2.414 [1.375-4.238], P=0.002; Tp-Te/QT, 1.886 [1.085-3.277], P = 0.024; Tp-Te/QTc, 1.873 [1.07-3.278], P=0.028, and negatively correlated with Glasgow outcome scale Tp-Te odds ratio [95% confidence interval], 4.168 [2.409-7.209], P<0.001; Tp-Te/QT, 2.434 [1.413-4.192], P=0.001; Tp-Te/QTc 2.953 [1.703-5.123], P<0.001).

CONCLUSIONS

Tp-Te, Tp-Te/QT, and Tp-Te/QTc are associated with disease severity and clinical outcome in patients with SAH.

摘要

背景

心电图（ECG）12 导联上 T 波峰至末端的间期（Tp-Te）延长与室性心律失常有关。本研究旨在明确 Tp-Te、Tp-Te/QT 和 Tp-Te/校正 QT（QTc）与蛛网膜下腔出血（SAH）临床严重程度和临床结局之间的关系。

方法

本回顾性研究纳入了 222 例急性 SAH 患者（S 组）和 306 例未破裂脑动脉瘤患者（U 组）。在入院时对标准 12 导联心电图记录进行手动测量 Tp-Te、Tp-Te/QT 和 Tp-Te/QTc，并比较 S 组和 U 组患者之间的差异。使用多因素逻辑回归分析校正混杂因素后，分析这些 ECG 参数与 Hunt 和 Hess 分级和格拉斯哥结局量表的关系。

结果

S 组的 Tp-Te、Tp-Te/QT 和 Tp-Te/QTc 明显大于 U 组（S 组：109±30、0.26±0.07 和 0.24±0.06 ms；U 组：84±12、0.22±0.03 和 0.21±0.03 ms，P<0.0001）。此外，在多因素逻辑回归分析中，这些变量与 Hunt 和 Hess 分级呈正相关（Tp-Te 比值比[95%置信区间]，2.414[1.375-4.238]，P=0.002；Tp-Te/QT，1.886[1.085-3.277]，P=0.024；Tp-Te/QTc，1.873[1.07-3.278]，P=0.028），与格拉斯哥结局量表呈负相关（Tp-Te 比值比[95%置信区间]，4.168[2.409-7.209]，P<0.001；Tp-Te/QT，2.434[1.413-4.192]，P=0.001；Tp-Te/QTc，2.953[1.703-5.123]，P<0.001）。