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目的了解克山病病区居民心脏健康状况及病情消长趋势,探讨最佳的防治方法与管理模式。方法 1979～1980年选历史重病区硒综合防治点泾川县罗汉洞村、灵台县万宝川农场和病情监测点泾川县向明村。2007～2009年按克山病防治项目技术方案要求,在崆峒、泾川、灵台、崇信、华亭和庄浪6个县区的9个病情调查点,对上述点区3岁以上常住农村人口均进行临床检查和12导联心电图描记,按克山病诊断标准、临床心电图学予以诊断和分析。结果 1979～1980年描记2 977例,检出异常心电图861例,检出率28.92%。2007～2009年描记5 632例,检出异常心电图780例,检出率13.85%,两次检出率差异有统计学意义(χ2=286.77,P<0.005)。1979～1980年成人心电图异常检出率39.43%,2007～2009年检出率16.20%(χ2=399.96,P<0.005);1979～1980年儿童心电图异常检出率11.6%,2007～2009年检出率4.90%(χ2=33.96,P<0.005)。异常心电图改变以窦性心动过缓、完全性右束支阻滞、低电压、ST-T改变、频发室性早搏为主,病区居民和克山病人心电图具有传导失常多、心肌损伤多、异位心律和心律失常多见等特点。结论平凉市病区居民异常心电图检出率明显下降,克山病患者心电图改变主要为完全性右束支传导阻滞、ST-T改变和频发室性早搏,病情处于稳定消退趋势。
Objective To investigate the heart health status of residents in Keshan disease area and the trend of disease growth and decline and to explore the best prevention and treatment methods and management models. Methods From 1979 to 1980, we selected Luohandong Village, Jingchuan County, Wanbaochuan Farm of Lingtai County, and Xiangmi Village, Jingchuan County, to monitor the condition of selenium in the seriously wounded area. According to the technical plan of Keshan Disease Prevention and Control Project from 2007 to 2009, nine rural residents in the above-mentioned sub-districts aged above 3 years were investigated at 9 investigation points in 6 counties of Qionglai, Jingchuan, Lingtai, Chongxin, Huating and Zhuanglang. The population were clinical examination and 12-lead ECG, according to Keshan disease diagnostic criteria, clinical ECG to be diagnosed and analyzed. Results A total of 2 977 tracings were performed between 1979 and 1980, 861 cases of abnormal electrocardiogram were detected, the detection rate was 28.92%. From 2007 to 2009, 5 632 tracings were performed. There were 780 cases of abnormal electrocardiogram detected, the detection rate was 13.85%. There was a significant difference between the two detection rates (χ2 = 286.77, P <0.005). From 1979 to 1980, the detection rate of abnormal electrocardiogram in adults was 39.43%, and the detection rate in 2007-2009 was 16.20% (χ2 = 399.96, P <0.005). The detection rate of electrocardiogram abnormality in children from 1979 to 1980 was 11.6% The rate of 4.90% (χ2 = 33.96, P <0.005). Abnormal electrocardiogram changes to sinus bradycardia, complete right bundle branch block, low voltage, ST-T changes, frequent premature ventricular contractions, ward residents and Keshan patients with abnormal conduction ECG, myocardial damage and more , Ectopic heart rhythm and arrhythmia more common and so on. Conclusion The detection rate of abnormal ECG in Pingliang ward residents decreased significantly. The changes of ECG in Keshan patients were mainly complete right bundle branch block, ST-T changes and frequent premature ventricular contractions.