动态心电图诊断无症状心肌缺血的价值

Value of dynamic electrocardiogram in the diagnosis of asymptomatic myocardial ischemia

目的探讨动态心电图诊断无症状心肌缺血的价值。方法选取2016年11月～2017年11月在我院心内科治疗的120例无症状心肌缺血患者作为研究对象,分别行常规心电图以及动态心电图检查,常规心电图作为对照组,动态心电图作为观察组,以冠状动脉造影结果作为金标准,比较两组的诊断的敏感度、特异度、准确度;并与同期120例有症状心肌缺血患者的动态心电图变化进行比较,并分析不同时间段无症状心肌缺血患者的动态心电图变化。结果观察组的敏感度、特异度、准确度均明显高于对照组,差异有统计学意义(P<0.05)。无症状心肌缺血者的心率高于有症状心肌缺血者,缺血持续时间短于有症状心肌缺血者,ST段压低幅度明显小于有症状心肌缺血者,差异有统计学意义(P<0.05)。无症状心肌缺血患者中,8:00～18:00的ST段下移幅度大于18:01～6:00,ST段下移持续时间短于18:01～6:00,心肌缺血阀变异性低于18:01～6:00,差异有统计学意义(P<0.05)。结论无症状心肌缺血患者运用动态心电图诊断的效果显著,准确度及敏感度高,能有效反映症状变化的规律,为临床的诊治提供有力依据。

Objective To investigate the value of dynamic electrocardiogram in the diagnosis of asymptomatic myocardial ischemia.Methods From November 2016 to November 2017,a total of 120 patients with asymptomatic myocardial ischemia treated in our department of cardiology were enrolled in the study.Routine electrocardiogram and dynamic electrocardiogram were performed respectively among patients.Routine electrocardiogram was used as control group and dynamic electrocardiogram was selected as observation group.The coronary angiography results were used as the gold standard to compare the diagnostic sensitivity,specificity and accuracy of the two groups.Meanwhile,these results were compared with dynamic electrocardiogram changes in 120 patients with symptomatic myocardial ischemia,and the dynamic electrocardiogram changes in patients with asymptomatic myocardial ischemia at different time points were analyzed.Results The sensitivity,specificity and accuracy of the observation group were significantly higher than those of the control group,and the difference was statistically significant(P<0.05).The heart rate of asymptomatic myocardial ischemia was higher than that of symptomatic myocardial ischemia,the duration of ischemia was shorter than that of symptomatic myocardial ischemia,the ST segment depression was significantly lower than that of symptomatic myocardial ischemia,and the differences were statistically significant(P<0.05).In patients with asymptomatic myocardial ischemia,the ST segment depression at 8:00-18:00 was more than that at 18:01-6:00,and the ST segment depression time was shorter than that at 18:01-6:00,variability of myocardial ischemic valve was lower than that at 18:01-6:00,and the differences were statistically significant(P<0.05).Conclusion The diagnosis of dynamic electrocardiogram in patients with asymptomatic myocardial ischemia is remarkable,with high accuracy and sensitivity,which can effectively reflect the regularity of symptoms,providing a substantial basis for clinical diagnosis and treatment.