摘要
目的探讨老年冠心病患者应用动态心电图(Holter)检测无症状心肌缺血(SMI)的临床效果。方法选取本院2010年1月—2012年12月收治老年冠心病168例为研究对象,分别对患者行常规性心电图检查及Holter检查,对比分析二种检测方法的临床诊断效果。结果本组患者中经常规心电图检查共发现48例患者出现心肌缺血症状,而Holter检查中则发现108例患者出现心肌缺血症状,二组患者心肌缺血检测率差异具有统计学意义(P<0.05),经Holter诊断可知,ST段阵次改变次数为504次,其中无症状心肌缺血改变为352阵次,有症状心肌缺血患者阵次改变为152阵次,无症状心肌缺血患者发生率显著高于有症状心肌缺血患者的发生率(P<0.05)。无症状心肌缺血患者发作具有昼夜性规律,在6:00—12:00的时间段内发作频率最高,而在0:00—6:00时段内发作频率最低。与有症状心肌缺血患者相比,无症状心肌缺血患者ST段下降的幅度及持续时间差异无统计学意义(P>0.05)。与有症状心肌缺血相比,无症状心肌缺血发作率更高,差异具有统计学意义(P<0.05)。结论老年人无症状心肌发生率高,症状不典型,常规的心电图检出率较低,采用Holter检测能及时发现无症状缺血心肌患者的存在,在临床上具有较高的诊断价值。
Objective To discuss clinical effect of dynamic electrocardiogram（Holter） on symptomless myo- cardial ischemia（SMI） in patients with coronary heart disease. Methods Total 168 elderly patients with coronary heart disease were selected as the research subjects in author＇s hospital from Jan. 2010 to Dec. 2012. All subjects received conventional electrocardiogram examination and Holter respectively, then the effect of the clinical diagnosis of two kinds of detection methods was analyzed. Results The myocardial is- chemia symptoms were found in 48 cases with regular ECG examination, and 108 patients were found with Holter examination. Detection rate of two kinds of test methods for myocardial ischemia patients was sta- tistical significance （P〈0.05）. The ST array changed 504 times by the Holter diagnosis, among them 352 episodes for symptomless myocardial ischemia and 152 episodes for symptomatic myocardial ischemia. The rate of the ST array changed was significantly higher in symptomless myocardial ischemia than that in myo- cardial ischemia. （P〈0.05）. The attack was day and night circadian regularity in patients with symptom- less myocardial ischemia, the highest frequency was in the morning 6：00--12：00, while minimum frequen- cy at 0：00 6：00 a.m. Compared with the patients with silent myocardial ischemia, silent myocardial is- chemia in patients with ST segment depression in amplitude and duration had no significant difference （P〉 0.05）. But symptomless myocardial ischemia attack rate was higher, the difference was statistically signifi- cant （P〈0.05）. Conclusions The positive rate of asymptomatic myocardial is low by conventional electro- cardiogram detection with a higher occurrence rate and not typical symptom in aged. The Holter detection can find no ischemic myocardium in patients with the presence of symptoms, which has high diagnostic val- ue in clinic.
出处
《中国煤炭工业医学杂志》
2013年第4期544-547,共4页
Chinese Journal of Coal Industry Medicine
