老年冠心病患者PCI后症状及动态心电图分析

Clinical analysis on their myocardium ischemia and symptoms in the elderly patients with coronary artery disease after percutaneous coronary intervention(PCI).

目的探讨老年冠心病患者经皮腔内冠状动脉成形术(PTCA)及支架置入术后心肌缺血与临床症状及心律失常的关系。方法对103例老年冠心病患者成功行PTCA及支架置入手术前后的临床症状及动态心电图结果进行统计分析。结果103例老年冠心病患者术后动态心电图显示24h心肌缺血发作次数、ST段压低幅度、ST段压低总时间、缺血发作平均时间和严重心律失常发生率和心脏事件发生率明显低于手术前(分别为4.1±1.1次vs9.1±1.6次,1.4±0.5mmvs3.0±0.6mm,28.3±5.6minvs207.1±13.3min,4.8±0.9minvs19.2±2.2min和25.2%.vs66.0%,p分别<0.001、<0.001、<0.001、<0.001和<0.001);动态心电图记录到的心肌缺血发作时,临床发生典型心绞痛症状的比例明显低于手术前(为7.8%vs43.7%,p<0.001),传导阻滞发生率无显著变化(p>0.05)。结论成功的PTCA及支架置入手术能明显改善冠心病患者心肌缺血发作次数、缺血程度、缺血持续的时间以及严重心律失常的发作次数,缓解心绞痛症状,提高生活质量;但对老年患者已存在的传导阻滞改善不明显。动态心电图可作为一种对PTCA及支架置入术疗效及患者预后有价值、无创性的评价方法。

Objective To investigate the relationship of performed percutaneous transluminal coronary angioplasty （PTCA） and/or stenting myocardium isehemia and their symptoms and arrhythmia in the elderly patients with coronary artery disease （CAD）, Methods The results of Holter from 103 elderly patients with CAD after PTCA and/or stenting compared with operation before were analyzed, Results The results of Holter that underwent PTCA were as the follow： the times of ischemia in 24 hours, the amplitude of ST segment degrading, the total time of ST segment degrading, the average time of ischemia, and the rate of serious arrhythmia were lower than those of operation before （4.1 ± 1.1 times ve 9.1 ± 1.6 times, 1.4 ± 0.5mm vs 3.0 ± 0.6mm, 28.3 ± 5.6min vs 207.1 ± 13.3min, 4.8 ± 0.9min vs 19.2 ± 2.2min,and 25.2% vs 66.0%. p 〈0.001, 〈 0.001, 〈 0.001, 〈 0.001, and 〈 0.001 respectively.）. The rates of typical angina pectoris with ischemia stroke in Hoher were lower than those of the operation before （7.8% vs 43.7%, p 〈 0.001 ）. The incidence of conduction block were not significant difference between the pre-operation and post-operation （p 〉 0.05 ）. Conclusion The successful PTCA operation were performed in the elderly patients with CAD is to make better myocardium ischemia. The times of ischemia, the degree of ischemia, the total time of ischemia, and the rate of serious arrhythmia gotten by Hoher were lower than those of the operation before. Their rates of typical angina pectoris with ischemia stroke were lower. But their rates of conduction block were not different. Holter test is an effective non-invasive method to evaluate PTCA and/or stenting and prognosis.