动态心电图对无症状心肌缺血的诊断价值

目的探讨动态心电图对无症状心肌缺血(SMI)的诊断价值。方法回顾性选择经冠脉造影确诊为冠心病的患者115例,且这些患者造影前已行动态心电图检查。采用动态心电图记录结合患者生活日志分析诊断及结果。结果符合心肌缺血性ST段压低发作要求(ST段压低≥0.1mV,持续时间≥1min,2次间隔≥1min)的有82例,占总例数的71.3%,其中共发生缺血性ST-T改变353阵次,其中SMI发生率(79.9%,282/353)高于症状性心肌缺血发生率(20.1%,71/353),差异有统计学意义(P<0.05)。06:00～12:00SMI发生率(52.8%,149/282)最高,0:00～06:00SMI发生率(8.9%,25/282)最低,差异有统计学意义(P<0.05)。SMI发作时,231阵次伴平均心率≥85次/min,占81.9%,51阵次伴平均心率<85次/min,占18.1%,SMI发生时心率快,差异有统计学意义(P<0.05)。结论动态心电图是无症状心肌缺血的有效的检查方法,对冠心病患者临床诊断和治疗具有重要意义。

Objective To investigate diagnostic value of DCG（Dynamic Electrocardiogram） monitoring for silent myocardial ischemia.Methods 115 patients who had been diagnosed by coronary angiography as coronary heart disease with DCG monitoring,analysis was conducted on the records of 24-hour Holter and Life log.Results There were 82 cases（71.3%） who had ischemic ST-segment changes（ST-segment depression≥0.1mv,duration≥1min,interval≥1min）,and ischemic ST-segment changes were 353 episodes.In these cases,silent myocardial ischemia were higher than symptoms of myocardial ischemia（79.9% VS 20.1%,P0.05）.Most frequent time happened myocardial ischemic was 06：00 to 12：00,while least frequent time happened myocardial ischemic was 0：00 to 06：00.When SMI attacks,it had faster heart rate,238 episodes correlate with the mean heart rate≥85bpm,44 episodes correlate with the mean heart rate85bpm（P0.05）.Conclusion Dynamic Electrocardiogram（DCG） is the effective method for silent myocardial ischemia,which are favorable to clinical diagnosis and treatment of coronary heart disease.