Wajon P, Lindsay G
Royal Prince Alfred Hospital, Sydney, Australia.
J Cardiothorac Vasc Anesth. 1998 Dec;12(6):620-4. doi: 10.1016/s1053-0770(98)90231-2.
To determine if the ST-segment monitoring software of a bedside electrocardiograph (ECG) monitor would detect postoperative myocardial ischemia (POMI) as reliably as the clinical gold standard 12-lead ECG, and to compare the characteristics of ischemia thus detected with prior studies performed using Holter monitoring.
Prospective study.
University hospital.
One hundred patients who had undergone coronary artery bypass grafting (CABG).
Continuous ST-segment trends in leads II and V5 were recorded using Hewlett-Packard Merlin monitors postbypass until discharge from the postsurgical unit, and printouts were analyzed for episodes of ischemia. Simultaneous 12-lead ECGs and monitor strips were recorded during ischemic episodes in 24 patients and were independently analyzed by two blinded cardiologists quantitatively for ST-segment values and qualitatively for an overall ischemia rating.
The ST-segment values directly measured by the cardiologists on the simultaneous 12-lead ECGs and those recorded by the monitor during ischemic episodes were found to be clinically comparable (bias, 0.1 mm for both leads; precision, 0.5 mm lead II, 0.9 mm lead V5). The sensitivity of the monitor compared with 12-lead ECGs for the detection of POMI was 73%. Ninety-eight episodes of significant ST deviation were identified in 39 patients. The characteristics of the ischemia detected in this study were similar to those reported in other studies performed using continuous Holter-type monitoring.
Bedside monitoring of the ST segment in leads II and V5 using Hewlett-Packard Merlin monitors after CABG surgery is as accurate for the measurement of ST deviation in those leads as the clinical gold standard of a 12-lead ECG read by an experienced cardiologist. However, the 12-lead ECG will detect POMI more reliably than an automated two-lead bedside ST-segment analyzer because it allows evaluation of more leads and of ST-segment and T-wave morphology. Bedside ST-segment monitoring in this study confirmed the high incidence of ischemia after CABG surgery shown previously using Holter monitoring.
确定床边心电图（ECG）监测仪的ST段监测软件检测术后心肌缺血（POMI）的可靠性是否与临床金标准12导联ECG相同，并将由此检测到的缺血特征与先前使用动态心电图监测进行的研究结果进行比较。
前瞻性研究。
大学医院。
100例行冠状动脉旁路移植术（CABG）的患者。
使用惠普Merlin监测仪在旁路手术后持续记录II导联和V5导联的ST段趋势，直至患者从外科病房出院，并对打印结果进行缺血发作分析。在24例患者的缺血发作期间同时记录12导联ECG和监测条带，并由两名不知情的心脏病专家独立进行定量分析ST段值和定性分析整体缺血评分。
心脏病专家在同步12导联ECG上直接测量的ST段值与监测仪在缺血发作期间记录的ST段值在临床上具有可比性（偏差，两个导联均为0.1 mm；精密度，II导联为0.5 mm，V5导联为0.9 mm）。与12导联ECG相比，监测仪检测POMI的灵敏度为73%。在39例患者中识别出98次显著ST段偏移发作。本研究中检测到的缺血特征与其他使用连续动态心电图监测进行的研究报告的特征相似。
CABG手术后使用惠普Merlin监测仪对II导联和V5导联进行床边ST段监测，对于测量这些导联的ST段偏移与经验丰富的心脏病专家读取的12导联ECG临床金标准一样准确。然而，12导联ECG检测POMI比自动双导联床边ST段分析仪更可靠，因为它允许评估更多导联以及ST段和T波形态。本研究中的床边ST段监测证实了先前使用动态心电图监测显示的CABG手术后缺血的高发生率。
