动态心电图监测在冠心病心肌缺血患者诊断中的临床价值研究

Clinical Value of DCG Monitoring in the Diagnosis of Silent Myocardial Ischemia in Patients with Coronary Heart Disease

目的:探讨动态心电图(DCG)监测在冠心病(CHD)无症状心肌缺血患者诊断中的临床价值。方法:105例CHD患者行DCG监测,观察无症状心肌缺血发生率、发作持续时间及ST段下降幅度,同时观察心肌缺血阀值(MIT)及变异性(IV)。结果:105例患者中无症状心肌缺血检出率为63.8%(67/105),ST段缺血性改变902阵次,有症状心肌缺血检出率为36.2%(38/105),ST段缺血性改变282阵次,无症状与有症状心肌缺血患者间差异有统计学意义(P<0.05),但发作持续时间与ST段压低幅度无显著差异(P>0.05);无症状心肌缺血患者白天发作阵次高于夜间,但发作持续时间、ST段压低幅度及MIT变异性(IV)则低于夜间,不同时间段差异有统计学意义(P<0.05)。结论:DCG监测能显著提高CHD无症状心肌缺血的检出率。

Objective：To explore the clinical value of DCG monitoring in the diagnosis of silent myocardial ischemia in patients with coronary heart disease（CHD）. Methods：105 cases of patients with CHD were given DCG monitoring, the incidence of SMI, ST-segment depression and duration of ischemic episodes were observed, at the same time to observe the myocardial ischemic threshold, variability of myocardial ischemic threshold. Results： 67 cases with asymptomatic myocardial ischemia were detected in 105 cases of patients,the detection rate was 63.8%（67/105）, the ischemic ST-T change had 902 episodes with symptoms of myocardial ischemia detected in 38 patients, the detection rate was 36.2%（38/105）, the ischemic ST-T change had 282 episodes, there was no significant difference（P〈0.05）;but there was no significant difference in the duration time and the extent of ST segment depression between silent myocardial ischemia and symptomatic myocardial ischemia（P〉0.05）. There were significantly different between daytime and nighttime in the episodes of ST-T change, the duration time, the extent of ST segment depression and the variability of myocardial ischemic threshold of patients with silent myocardial ischemia（P〈0.05）. Conclusions：DCG monitoring can significantly improve the detection rates of silent myocardial ischemia in patients with CHD.