老年男性冠心病患者无症状心肌缺血的研究

目的：探讨老年男性冠心病患者无症状心肌缺血的发作特点及规律。方法：选择老年男性冠心病（Ⅰ组）、冠心病合并高血压病（Ⅱ组）及冠心病同时合并高血压病、2型糖尿病（Ⅲ组）患者各66例，对其进行动态心电图检查。结果：动态心电图检出老年男性冠心病患者心肌缺血主要为无症状心肌缺血（SMI）；SMI发生率Ⅲ组〉Ⅱ组〉Ⅰ组（P〈0．05），Ⅲ组的SMI总次数与Ⅱ组、Ⅰ组比较有显著差异（P〈0．05）；SMI持续时间Ⅲ组与Ⅱ组比较有显著差异（P〈0．05）；三组的发作高峰均在上午。日间SMI发生次数明显多于夜间，夜间SMI发生比例Ⅲ组与Ⅰ组比较有显著差异（P〈0．05），Ⅲ组昼夜SMI平均持续时间有显著差异（P〈0．05）。结论：高血压病、2型糖尿病均可增加老年男性冠心病患者SMI的发生，尤其是夜间的发生：动态心电图是老年男性冠心病，特别是合并高血压、2型糖尿病患者SMI的重要检测手段。

Character of silent myocardial ischemia attacking in aged patients with coronary heart disease

Objective： To study the character of silent myocardial ischemia attacking in aged patients with coronary heart disease （CHD）. Methods： The 24 h dynamic electrocardiogram （DCG） monitoring was performed in all aged male CHD patients. The 196 subjects were averagely divided into CHD group （group Ⅰ ）, CHD combined with hypertension group （group Ⅱ ）, CHD combined with hypertension and diabetes mellitus type 2 group （group Ⅲ ）. Results： The silent myocardial ischemia （SMI） was detected by DCG. SMI occurred rate, the general times of SMI were more in group Ⅲ than those in group Ⅱ and group Ⅰ （P〈0.05 all） ： The duration of SMI was significantly longer in group Ⅲ than that in group Ⅱ （P〈0.05） ： The peak of SMI occurrence was in morning in three groups, the daytime SMI occurs more often than in nighttime （P〈0.05）. Nighttime SMI occurred more frequency in group Ⅲ than that in group Ⅰ （P〈0.05）. The average duration of SMI was more long in daytime than that in nighttime in group Ⅲ （P〈 0.05）. Conclusion： The hypertension and diabetes mellitus type 2 can increase the occurrence of SMI in male aged coronary heart disease, especially of nighttime. DCG is an important means of detection and evaluation to the aged coronary heart disease, especially combined with hypertension and diabetes mellitus type 2.