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阜外心电图运动试验

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心电图运动试验是心电图学的重要组成部分。追溯其发展,从20世纪30年代起,运动试验就开始受到重视;在40—50年代期问,学者们对二阶梯运动试验进行了深入的研究;至50年代中期以后,二阶梯运动试验逐渐被平板运动试验和踏车运动试验所取代。随着国际上相关研究的进展和我国经济发展水平的变化,阜外心血管病医院在心电图运动试验的临床应用方面,也经历了一个较长的发展过程。1957年黄宛教授首先开展了二阶梯运动试验,该方法一直沿用至20世纪70年代末。直至我国上海可自行生产平板运动仪,我院才开始相对较多地应用平板运动试验。由于当时心电图记录为单导联、平板运动仪为手动操作、与心电图记录不同步等原因,每日接受平板运动试验检查的患者很有限。而自1984年引进了国外先进的平板运动仪后,我院心电图运动试验的临床应用逐年增加。目前,阜外医院的平板运动试验的病例数已达13000人次/年,累积病例已逾10万例。如此大量的工作,使我们积累了丰富的临床经验,也为我们出版《阜外心电图运动试验》提供了丰富的病例资料。
《阜外心电图运动试验》一书主要突出其临床实用性。通过大量详实的运动试验病例资料,结合国际上有关运动试验的指南和研究进展进行分析,帮助广大的心电学工作者和内科医生提高对心电图运动试验的认识。本书的另一特色是提供的大多数运动试验病例结果都经过了冠状动脉造影、同位素运动负荷试验或多排CT检查的证实或印证,并对假阳性或假阴性结果进行了具体分析,同时邀请从事同位素运动负荷试验、超声运动负荷试验和多排CT研究的专家撰写相关章节,相信有助于大家更加深人的认识各项检查方法诊断冠心病的优势和不足。另外,本书还较详细地介绍了运动试验在心肌梗死后危险评估和运动康复、PCI和cABC术后疗效评估和再狭窄预测、评价心功能不全、对无症状人群的筛选和在特殊人群中的应用等内容,相信有助于读者对心电图运动试验得到更全面的认识。
Author Description

方丕华,男,1958年生,医学博士,籍贯湖南。中国医学科学院心血管病研究所,中国协和医科大学阜外心血管病医院心律失常诊治中心教授、主任医师、博士生导师。兼任阜外心血管病医院功能检测中心主任,中华医学会心电生理和起搏分会无创心电学组副组长,中国心电信息学分会副主任委员。1982年毕业于湖南医科大学医学系,获医学学士学位。毕业后一直从事临床医疗工作,先后在中国协和医科大学获得硕士和博士学位。1998年10月至2001年9月先后在意大利著名的帕维亚大学和美国的威克林大学医疗中心从事博士后研究3年,主攻心律失常的标测和介入治疗。2001年底学成回国后专门从事心脏起搏和心律失常的介入治疗。先后承担首都医学发展基金、北京自然科学基金和国家科技部等省部级科研任务6项,发表在国内外医学杂志的专业论文70余篇。已主译和主编专著5部。
专业特长:室上性心动过速、室性心动过速、房性心动过速、心房颤动、心房扑动等电生理检查和射频消融、起搏器植入和随访、无创心电学检查的诊断及心血管内科疾病的诊治。
主要研究方向:各种心律失常的机制和介入治疗,以及用无创心电学方法对心脏性猝死进行危险性分层研究。
Catalogue

第一章运动负荷试验的历史回顾
第二章心电图运动试验的生理学基础
第三章心电图运动试验的适应证和禁忌证
第四章常用心电图运动试验方法
第五章常用运动方案
第六章检查步骤
第七章试验结果判断
第八章运动试验中的临床表现和心电图变化意义
第九章运动试验并发症的处理
第十章心电图运动试验的实例分析
第十一章急性心肌梗死后运动试验的临床应用
第十二章运动试验在PCI术后评价其疗效和再狭窄的作用
第十三章运动试验在PCI术后指导心脏康复和评价其预后的作用
第十四章冠状动脉搭桥术后运动试验的临床应用
第十五章运动试验在评价心功能不全中的应用
第十六章运动试验对无症状人群的筛选作用
第十七章儿童运动试验
第十八章儿童运动试验的国际指南解读
第十九章女性负荷运动试验
第二十章运动试验在心血管疾病预测中的作用
第二十一章心电图运动试验与超声心动图负荷试验的对比研究.
第二十二章代谢异常和药物
第二十三章心肺运动试验
第二十四章 多排螺旋CT在冠心病诊断中的临床应用
第二十五章超声心动图负荷试验
第二十六章放射性核素心肌灌注显像与心脏负荷试验
第二十七章各种心脏负荷试验的比较及评价
第二十八章ACC/AHA运动试验的指南解读
附录 ACC/AHA运动试验指南
Book Abstract

运动试验中对血压的监测是不可忽视的一项内容,正常情况下,血压会随运动量的增加而升高,运动开始时血压升高明显,如果在运动中血压过度升高或没有变化、或血压下降都是一种危险信号。
运动试验用的血压监测仪是专用设备,它不同于普通血压计,他要在人体运动中准确测量血压,并将测量的血压数据送入运动试验的监测数据库中,与心电图等资料同步储存并显示在屏幕上。血压的测量时间由事先编好的程序控制,通常是在每一级运动结束前30秒测量一次,也可由操作人员随时启动测压。
运动中如果患者的心电图出现严重心律失常、心室率减慢、ST段抬高、血压显著升高、血压降低、呼吸困难以及患者体力不支等要立即终止运动试验,必要时给予相应的治疗。
六、患者的准备
1.运动前准备需要做运动负荷试验检查的患者除了要签署知情同意书外,还需让患者了解运动平板机的工作特性,紧急制动按钮的使用,走板的姿态、步伐等。
患者应在试验前2~4小时内禁食、不饮咖啡、不吸烟,同时准备饮用水一瓶,贴身的内衣裤应当是稍宽松的全棉制品,最好穿着运动服装。试验前12小时不应进行超常的体力劳动。试验前24~48小时停用心脏活性药物。但是,停用B受体阻滞剂(较大剂量)时会产生“反跳现象”,因此,这些患者在做试验时仍可服用原药。我们不仅需要知道患者在服用什么药物,还应注意有无电解质异常和其他因素的影响。
2.运动中注意事项运动负荷试验中患者应当全身放松,认真走好平板,在试验过程中出现不适症状时应及时与医技人员沟通,必要时申请终止试验,不允许患者在体力不支或出现异常感觉时坚持试验。
3.运动后注意事项运动负荷试验终止后患者不应马上停止运动,特别是在较高级别上结束试验后应慢走30秒至1分钟。
Introduction

心电图创始人Einthoven早在1908年就观察到运动后心电图上sT段压低的现象。1929年Master首次发表了有关运动负荷试验的论文。12年之后,1941年Master又首先提出了运动负荷试验可以检测冠状动脉的功能状态。此后,有关运动负荷试验的方法、方案、观察指标和临床意义评估的研究逐渐增多。总体上,20世纪40年代初到50年代中期,运动试验方法主要是二阶梯运动试验,1956年后运动试验逐渐发展为乎板运动和踏车运动试验。
我国心电图运动试验起步相对较晚。随着国际上相关研究的进展和我国经济发展水平的变化,在心电图运动试验的研究方面,我国也经历了一个较长的发展过程。20世纪50年代首先开展了二阶梯运动试验,该方法一直沿用至20世纪70年代末。80年代初我国上海自行研制和生产平板运动仪后,平板运动试验才开始较多地应用于临床。近十年来同位素运动负荷试验和超声运动负荷试验的临床应用也逐渐增多。但由于心电图运动试验设备简单、价格低廉、简便安全和具有较高的敏感性和特异性等特点,目前仍是我国主要应用的一种运动负荷试验方法。
近年来国际上有关心电图运动试验的方法、方案、诊断标准及临床意义方面的研究又有许多进展,特别是有关运动试验在心肌梗死后危险评估和运动康复、PCI和cABG术后疗效评估和再狭窄预测及在特殊人群中的应用等方面都有许多新的成果。
方丕华教授主编的《阜外心电图运动试验》一书系统地总结了阜外心血管病医院开展心电图运动试验五十余年以来,积累的十余万病例的丰富经验,选择部分典型和少见病例,结合国际上有关心电图运动试验研究的新进展进行分析讨论。相信本书可以成为广大心电学工作者和内科医师的良书益友,对提高心电图运动试验在冠心病诊断和心血管病危险性分层等方面的临床应用和认识水平上有更大帮助。

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