动态血压心电图同步监测评价高血压患者的心肌缺血

SIMULTANEOUS AMBULATORY ELECTROCARDIOGRAM AND BLOOD PRESSURE MONITORING IN DETECTING MYOCARDIAL ISCHEMIA IN PATIENTS WITH SYSTEMIC HYPERTENSION

采用动态血压、心电图同步二合一监测技术评价高血压患者 2 4h心肌缺血发作的规律及其与血压、心率波动的关系 .152例患者中 38例发现 175次ST段压低 ,持续 (10± 12 )min ,压低幅度 (1.4± 0 .4 )mm ,以清晨和傍晚为发病高峰 .ST段下移组血糖、血胆固醇及收缩压水平增高 (P <0 .0 5) .ST段压低组较无ST段压低发生昼夜节律消失的构成比有显著差异(P <0 .0 5) .ST段压低时心率明显加快 (P <0 .0 0 1) ,且ST段压低幅度与压低时最大心率、2 4h平均收缩压、心肌耗氧量呈正相关 (P <0 .0 0 1,P <0 .0 5) .即使在无冠心病临床证据的高血压患者中也常有一过性心肌缺血发生 (发生率 2 5% ) ,与动态血压负荷增加、心率加快有关 .

To assess the prevalence and circadian distribution of ST segment depression in patients with systemic hypertension and the influence of heart rate (HR) and blood pressure(BP)on episodes of ischemia, anbulatory electrocardiographic and BP monitoring were simultaneously performed in 152 patients. The total of 175 episodes of significant ST segment depression could be demonstrated in 38 patients. The total duration of such episodes was (10±12) minutes and average amplitude was (1.40±0.40) mm. Circadian distribution showed 2 peaks: an early morning (7:00～8.00) and the late afternoon periods. Plasma glucose and total cholesterol were higher in patients with ST segment depression ( P <0.05). The mean ambulatory BP load and day or night mean BP were greater in patients with than without ST segment depression for systolic BP ( P <0.05). In blood pressure non dipper group the occurrence of ST segment depression was higher than that of the dipper group ( P <0.05). In comparison with HR before and after ST segment depression, HR during the episodes increased remarkably ( P <0.001). The extent of ST segment depression was correlated to systolic BP, HR and HR×systolic BP product. Transient myocardial ischemia is a frequent phenomenon in systemic hypertensive patients. 24 hour Holter monitoring showed ST segment depression in 25% of patients; ambulatory BP load was greater in these patients, whereas episodes of ischemia were accompanied by an elevation in HR.