动态心电图监测老年冠心病无症状心肌缺血的临床分析

Clinical Analysis of Dynamic Electrocardiogram Monitoring Asymptomatic Myocardial Ischemia in Elderly Patients with Coronary Heart Disease

目的通过对不同组老年冠心病患者分别实施动态心电图和常规心电图监测,观察其临床效果,探究不同方法的临床特点。方法从来该院诊治的2016年1月—2018年10月的老年冠心病无症状心肌缺血患者中随机抽取58例,采用随机数字法随机分为对照组29例:实施常规心电图监测,观察组29例:实施动态心电图监测,对于无症状性心肌缺血组和有症状性心肌缺血组患者均实施放射性核素检验;分别比较无症状心肌缺血阳性检出率、ST段压低幅度、ST段压低时心率、缺血持续时间情况。结果观察组无症状心肌缺血阳性检出率为86.21%,对照组为68.97%,观察组无症状心肌缺血阳性检出率高于对照组(χ^2=11.453,P<0.05);无症状性心肌缺血组患者ST段压低幅为(1.68±0.04)mV与有症状性心肌缺血组患者(1.73±0.05)mV,差异无统计学意义(t=1.546,P>0.05),ST段压低时心率为(82.42±1.09)次/min高于有症状性心肌缺血组(74.83±1.94)次/min,差异有统计学意义(t=11.492,P<0.05),缺血持续时间为(12.42±1.09)min,高于有症状性心肌缺血组(7.83±0.94)min,差异有统计学意义(t=10.537,P<0.05)。结论动态心电图可以有效提高老年冠心病无症状心肌缺血阳性检出率,可以帮助临床医师做到病情的早期防控,抑制心血管意外事件的发生率,改善患者预后。

Objective To observe the clinical effect of dynamic electrocardiogram(DCG)monitoring in different groups of elderly patients with coronary heart disease(CHD)and explore the clinical characteristics of different methods.Methods From January 2016 to October 2018,a total of 58 elderly patients with asymptomatic myocardial ischemia of coronary heart disease were randomly selected and divided into control group(29 cases)with conventional electrocardiogram detection and observation group(29 cases)with dynamic ECG monitoring.Radionuclide test was performed in both asymptomatic and symptomatic myocardial ischemia groups.The positive detection rate of asymptomatic myocardial ischemia,the amplitude of ST-segment depression,heart rate and duration of ischemia during ST-segment depression were compared.Results The positive detection rate of asymptomatic myocardial ischemia was 86.21%in the observation group and 68.97%in the control group.The positive detection rate of asymptomatic myocardial ischemia in the observation group was higher than that in the control group(χ^2=11.453,P<0.05).There was no difference in ST segment depression between the asymptomatic myocardial ischemia group(1.68±0.04)mV and the symptomatic myocardial ischemia group(1.73±0.05)mV,the difference was statistically significant(t=1.546,P>0.05).The heart rate at ST segment depression was(82.42±1.09)beats/min in asymptomatic myocardial ischemia group,which was higher than that in symptomatic myocardial ischemia group(74.83±1.94)beats/min(t=11.495,P<0.05),and the duration of ischemia was(12.42±1.09)min,which was higher than that in symptomatic myocardial ischemia group(7.83±0.94)min(t=10.537,P<0.05).Conclusion Dynamic electrocardiogram can effectively improve the positive detection rate of asymptomatic myocardial ischemia in elderly patients with coronary heart disease,help clinicians to achieve early prevention and control of the disease,inhibit the incidence of cardiovascular accidents,and improve the prognosis of patients.