动态心电图在老年无症状性心肌缺血诊断中的应用价值

Application Value of Ambulatory Electrocardiogram in the Diagnosis of Elderly Silent Myocardial Ischemia

目的探讨动态心电图在老年无症状性心肌缺血(SMI)临床诊断中的应用价值。方法将收治的78例老年SMI患者纳入研究,所有患者均接受常规心电图及动态心电图检查。对比常规心电图与动态心电图检出SMI的阳性率、并记录患者SMI发作规律及动态心电图检出SMI昼夜规律。结果78例老年SMI患者中,常规心电图检查确诊SMI的检出率(47.44%)低于动态心电图检出率(78.49%),差异有统计学意义(P<0.05);患者SMI发作高峰时段为12:00~13:00(73次.h),中间时段为8:00~9:00(58次/h)和10:00~11:00(39次/h),低谷时段为1:00~2:00(3次/h)。夜间ST段下移发作次数少于日间,心肌缺血持续时间长于日间,ST段位移大于日间,心肌缺血发作时心率低于日间,差异有统计学意义(P<0.05)。结论相比于常规心电图,动态心电图更适用于老年SMI诊断,可提高SMI检出率,反映患者病情规律特点,以便及时医治,具有较高的临床应用价值。

Objective To explore the application value of dynamic electrocardiogram in the clinical diagnosis of elderly silent myocardial ischemia(SMI).Methods A total of 78 elderly patients with SMI treated were included in the study.All patients underwent routine electrocardiogram and dynamic electrocardiogram.The positive rate of SMI detected by conventional electrocardiogram and dynamic electrocardiogram was compared,and the regularity of SMI onset in patients and the day-night pattern of SMI detected by dynamic electrocardiogram were recorded.Results Among 78 elderly patients with SMI,the detection rate of SMI confirmed by routine electrocardiogram(47.44%)was lower than that of dynamic electrocardiogram(78.49%),and the difference was statistically significant(P<0.05).The peak period of SMI episodes in patients was 12:00-13:00(73 times.h),and the intermediate periods were 8:00-9:00(58 times/h)and 10:00-11:00(39 times/h).The trough period is 1:00-2:00(3 times/h).The number of ST-segment shifts at night was less than daytime,the duration of myocardial ischemia was longer than that of daytime,the ST-segment shift was greater than that of daytime,and the heart rate was lower than that of daytime during myocardial ischemic attack.The difference was statistically significant(P<0.05).Conclusion Compared with conventional electrocardiogram,dynamic electrocardiogram is more suitable for the diagnosis of elderly SMI,which can improve the detection rate of SMI,reflect the characteristics of the patient's condition,so that it can be treated in time,and has higher clinical application value.