98例老年患者24 h动态心电图增龄性变化特征分析

Characteristics of aging changes in 24-hour dynamic electrocardiogram of 98 elderly patients

目的探讨老年患者24 h动态心电图(ambulatory electrocardiograph,AECG)增龄性变化特征。方法回顾性分析在我院住院行12导联24 h AECG患者的检查资料,同时满足如下条件:①本地常住;②首次AECG年龄≥60岁;③同一患者至少有两次AECG检查,其中首次与末次检查时间间隔至少5年;④无心脏起搏器植入;⑤有完整的生活日志,包括作息时间、日常活动及症状发生的起止时间等。符合条件者共98例,调阅患者住院病案,统一标准,再次逐份分析AECG,分析比较两次AECG检测的24 h平均心率、最慢心率、最快心率及心律失常和ST段缺血性压低发作情况。结果98例老年患者随年龄增长,24 h平均心率、最慢心率、最快心率均呈减慢趋势,且差异有统计学意义(P<0.001);各种心律失常均呈增多趋势,其中Lown分级≥Ⅲ级室早从无增加到10例,而合并3种及以上心律失常从18例(18.37%)增加到67例(68.37%)(P<0.001);ST段缺血性压低首次检测有28例共125阵次,其中无症状心肌缺血(silent myocardial ischemia,SMI)82阵次,有症状心肌缺血43阵次,末次检测有60例共272阵次,其中SMI 214阵次,有症状心肌缺血58阵次,SMI、有症状心肌缺血ST段缺血性压低阵次随年龄增长均增加,其中SMI增加显著(P<0.001)。所有患者ST段缺血性压低均呈昼夜变化规律,但随年龄增长昼夜变化规律呈减弱趋势,其中SMI昼夜变化趋势明显减弱(P=0.535)。结论老年患者24 h AECG增龄性变化特征明显,定期AECG检查有重要价值。

Objective To explore the characteristics of aging changes in 24hour ambulatory electrocardiogram(AECG)of elderly patients.Methods The data of 12lead 24hour AECG from our hospital were retrospective analyzed,and the following conditions were required:①Local resident;②The age of the patient is no less than 60 when taken first AECG;③The same patient should take at least two AECG examinations,with an interval of at least 5 years between the first and the last examination;④No cardiac pacemaker implantation;⑤There is a complete life log,including work and rest time,daily activities,and when symptoms start and end,etc.A total of 98 patients were enrolled.The hospitalized medical records of the patients were reviewed,and the standard was developed.The 24hour mean heart rate,slowest heart rate,fastest heart rate,arrhythmia and ST segment ischemic attack detected by AECG were analyzed and compared between the two AECGs.Results With the increase of age,the 24hour mean heart rate,the slowest heart rate and the fastest heart rate of 98 elderly patients all showed a tendency of slowing down with statistical difference(P<0.001).All kinds of arrhythmias showed an increasing trend,among which the case of ventricular premature with Lown grade≥Ⅲincreased from 0 to 10 cases,while the case of arrhythmias contained 3 or more types increased from 18(18.37%)to 67(68.37%)(P<0.001).Twentyeight cases(125 times)of ST segment ischemic depression were detected in the first examination,including 82 times of silent myocardial ischemia(SMI),43 times of symptomatic myocardial ischemia.Sixty cases(272 times)of ST segment ischemic depression were detected in the last examination,including 214 times of SMI and 58 times of symptomatic myocardial ischemia.The number of both SMI and symptomatic myocardial ischemic ST segment ischemic depression increased with age,and SMI increased significantly(P<0.001).All the patients showed a circadian rhythm of ST segment ischemic depression,but this circadian rhythm was weakened with the age growth,especially for SMI(P=0.535).Conclusions The elderly patients showed significant agerelated changes in 24hour AECG,and regular AECG examination is of great value.