老人健康檢查心電圖異常之探討

Electrocardiographic Abnormalities on General Health Examination in the Elderly

陳怡如(Yi-Ju Chen) ； 張哲明(Che-Ming Chang)

《北市醫學雜誌》 2卷6期 (2005/06) Pp. 554-566

https://doi.org/10.6200/TCMJ.2005.2.6.07

摘要

目的：台灣已於1993年進入老年化國家，老年醫學成為社區醫學與各醫學領域裹極重要的一環，老人健檢的服務也已有多年成效。隨著國人飲食生活型態的改變，慢性疾病當中心臟血管相關疾病所導致的死亡率正逐年增加，心血管疾病預防與篩檢已成為歷年來中老年疾病防治重點之一。在許多健檢組台中，靜態心電圖檢查方便、效益高、不具侵襲性，多年來已成為每年台北市老人健康檢查必定納入的項目。然而心電圖報告多由心臟科專科醫師在無法對受檢者印證臨床表徵情形下判讀，執行健檢諮詢的醫師對於各項異常診斷的意義評估與轉診時機的判斷就非常重要。有關無症狀老年受檢者的心電圖執行情形與異常表現、正常老化與疾病表現的比例概況分析向來較缺乏。方法：陽明院區家庭醫學科團隊以九十二年度執行老人健康檢查的受檢者為對象進行心電圖異常表現的統計，希望提供日後建檢諮詢及相關專家在瞭解基層老人健檢概況的參考。陽明院區在九十二年總共為4117位長者執行老人健康檢查，排除資料不完整個案，共計4087位，其中男性2315位(56.6%)、女性1772位(43.4%)，將診斷結果與以統計分析。結果：研究發現含一項或一項以上異常者，男性有1,725位（佔男性受檢者74.5%）、女性有1,183位（佔女性受檢者66.8%）。心電圖的異常表現，依發生率排列如下：竇性心搏過緩14.3%、心軸逆時鐘偏轉10.6%、導程低電位9.9%、左心房擴大9.7%、心軸偏左7.5%、左心室肥大6.8%、心肌缺氧及缺血5.9%、完全性右束枝傳導阻滯4.9%、非特異性ST-T變化4.8%、第一度房室傳導阻滯4.3%、疑似或確定陳舊性心肌梗塞4.2%、心房早期收縮2.7%、心室早期收縮2.3%、心房纖維顫動2.2%，左前束枝半阻斷1.9%、不完全性右束枝傳導阻滯1.2%。結論：本研究針對老人健檢常見心電圖異常項目提出統計分析，再與性別、病史、年齡層、抽煙、喝酒、代謝性指標等變項作進一步分析。嘗試以基層的角度報告老人健檢裏心電圖異常分佈情形與其他變項的關聯，有助於提供基層醫師執行健檢諮詢、及相關專家在瞭解基層老人健檢概況的參考。

關鍵字

心電圖 ； 老人健檢 ； 老年醫學

並列摘要

Background and Purpose: Data from the Social Affairs Department of the Ministry of the Interior, R.O.C., demonstrated that Taiwan became an elderly country in 1993. Life styles rapidly changed as industrialization and urbanization occurred in Taiwan and the mortality rate from heart disease increased, therefore prevention of heart disease has been emphasized during the past few decades. Many periodic health checkups include electrocardiograms, as they are a simple and useful technique. However, there has been a lack of electrocardiogram analysis in asymptomatic elderly people, and the interpretation of ECGs is usually done by a cardiologist without assessing the patients' clinical condition and personal history. As general practitioners, we have to pay more attention, and understand more of how to explain and when to refer each common disorder from electrocardiograms of asymptomatic patients. Methods: We collected data from the 4,087 persons who had undergone a complete, periodic elderly health check-up in the Yangming Branch of Taipei City Hospital. The ECG data were interpreted by cardiologists and abnormal findings were analyzed. Results The rate of abnormalities (at least one or more) was 1,725 in elderly males (74.5% of male examinees) and 1,183 in elderly females (66.8 % of female examinees). The common abnormalities analyzed in this report include: sinus bradycardia (14.3%), counter-clockwise rotation (10.6%), low voltage (9.9%), left atrial enlargement (9.7%), left axis deviation (7.5%), left ventricular enlargement (6.8%), myocardial ischemia (5.9%), complete right bundle branch block (4.9%), nonspecific ST-T change (4.8%), first degree A-V block (4.3%), suspected or definable old myocardial infarction (4.3%), atrial premature contraction (2.7%), ventricular premature contraction (2.3%), atrial fibrillation (2.2%), left hemi-bundle branch block (1.9%), incomplete right bundle branch block (1.2%).Chi-square tests were conducted to explore the significance between the electrocardiogram findings and other factors include gender, age, alcohol, smoking, BMI, blood pressure, blood sugar and lipids. Conclusion: In this article, we report the common abnormalities in elderly peoples electrocardiograms from our hospital's experience and introduce periodic elderly health check-ups in Taipei. According to the results, we will also perform a review and discussion from textbooks and articles for general practitioners.

並列關鍵字

electrocardiogram ； elderly health examination ； geriatric medicine