无症状性心肌缺血的动态心电图分析

Dynamic electrocardiographic analysis of silent myocardial ischemia

目的分析无症状性心肌缺血（SMI）患者的动态心电图特点,为临床诊断SMI提供依据。方法 230例冠心病患者为研究对象,对其进行24 h动态心电图监测,分析其动态心电图特点。结果 230例冠心病患者共检出心肌缺血216例,检出率为93.9%,SMI发生率明显高于有症状性心肌缺血,差异有统计学意义（76.4%VS 23.6%,P〈0.05）。216例患者中缺血性ST段改变共488阵次,SMI缺血性ST段发生率明显高于有症状者,差异有统计学意义（83.0%VS 17.0%,P〈0.05）。SMI以6：00～22：00之间发生最多,共131例（79.4%）,而22：00～6：00之间发生34例（20.6%）;白天发作时平均心率明显高于夜间心率[（88.2±6.5）次/min VS（79.6±6.2）次/min,P〈0.05]。165例SMI患者中男性96例,女69例,男性平均心率略高于女性,但二者间差异无统计学意义[（82.4±5.8）次/min VS（80.6±5.4）次/min,P〉0.05]。结论无症状性心肌缺血患者缺乏临床症状,动态心电图可以为其提供可靠地依据。

Objective To analyze the feature of dynamic electrocardiogram（ECG） of silent myocardial ischemia（SMI） patients to provide basis for clinical diagnosis of SMI. Methods Selected 230 cases of coronary heart disease patients as research objects, its 24-hour Holter monitor, analyzed its dynamic ECG features. Results Out of 230 cases of coronary heart disease patients, 216 cases of myocardial ischemia were detected, the detection rate was 93.9%, incidence of SMI was significantly higher than symptomatic myocardial ischemia, the difference was statistically significant（76.4% VS 23.6%, P〈0.05）. 216 cases of patients with ischemic ST segment changes array for 488 times, incidence of SMI ischemic ST segment was significantly higher than symptomatic myocardial ischemia, the difference was statistically significant（83.0% VS 17.0%, P0.05）. 131 cases（79.4%） of SMI occurred between 6：00～22：00, 34 cases occurred（20.6%） between 22：00～6：00; average heart rate during the day was significantly higher than in night[（88.2±6.5）beats/min VS（79.6±6.2）beats/min, P0.05]. 165 cases of patients with SMI, male（96 cases） heart rate slightly higher than female（69 cases）, but no significant difference between two[（82.4±5.8）beats/min VS（80.6±5.4）beats/min, P〉0.05]. Conclusion For SMI is lack of clinical symptoms, dynamic electrocardiographic monitoring can provide a reliable basis.