Holter监测冠心病无痛性心肌缺血发作规律的研究

The study of regularity of silent myocardial ischemia attack in coronary artery disease by surveillance of Holter

目的 探讨冠心病无痛性心肌缺血的发作规律。方法 对确诊的 486例冠心病患者 ,进行 2 4小时Holter监测 ,观察无痛性心肌缺血发作的次数、时间及其与活动状态的关系。结果 486例冠心病患者中发生无症状性心肌缺血者 335例 ,共 6 98次 ,累计时间为 35 2 6分钟。其中 6 19次与活动有关。 6 :0 0～ 12 :0 0为无痛性心肌缺血发作高峰期 ,在此期间共发作 389次 ,累计时间为 2 10 0分钟。具有无痛性心肌缺血的冠心病患者的死亡率为 13 0 2 %,高于有症状的冠心病患者的 4 72 %。两组死亡率间差别有显著性意义 (P <0 0 5 )。结论 无痛性心肌缺血的发作有一定的规律 ,掌握该规律对于指导临床治疗、降低心脏猝死及预防心肌缺血的发作有一定的作用。

Objective To study the attack regularity of silent myocardial ischemia (SMI) in patients with coronary artery disease.Methods Holter monitor was used to observe the silent myocardial ischemia attack in 486 cases with coronary heart disease.The relationship among the attack times,the period and the activities was analyzed.Results There were 335 cases (698 times) has found silent myocardial ischemia in 486 cases.The total period was 3526 minutes.There were 619 times (88.68%) related with activity.More silent myocardial ischemia happened from 6∶00 a.m. to 12∶00 a.m.,there were 389 times in this period,the total attack time was 2100 minutes.The death rate (13.02%) of the cases with SMI was high than those without SMI (4.72%).There were significant differences between death rate in two groups(P<0.05).Conclusion SMI attack has some regular rule,which might be used to guide clinic treatment so as to reduce the attack of sudden death due to heart failure and myocardial ischemia.