动态心电图在老年女性冠心病患者无症状心肌缺血的研究

目的探讨老年女性冠心病患者无症状心肌缺血的发作特点及规律。方法选择老年女性冠心病采用12导联动态心电图记录系统,对109例冠心病患者连续监测24 h,结合患者生活日志分析诊断;109例分成三组：Ⅰ组单纯冠心病组（无高血压糖尿病）、Ⅱ组冠心病合并高血压组、Ⅲ组冠心病合并高血压与2型糖尿病。结果动态心电图检出老年女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）。结论二级预防的老年女性冠心病人仍有较高的SMI发生率,应和有症状心肌缺血同样给予足够重视。高血压病、2型糖尿病均可增加老年女性冠心病患者SMI的发生,尤其是夜间的发生。动态心电图是老年女性冠心病,特别是合并高血压、2型糖尿病患者SMI的重要检测手段。

Clinical value of silent mycardical ischemia on dynamic electrocardiogram in aged female patients with coronary artery disease

Aim To explore the clinical characteristic and occurrence rule of silent myocardial ischemia （SMI） in old women patients with coronary artery disease. Methods 24-hour dynamic electrocardiogram monitoring was performed in 109 CAD patients . The 109 patients were divided into 3 group：pure CAD, CAD with hypertension, CAD with hypertension and type 2 diabetes mellitus. Results The results indicate that silent myocardical ischemic（SMI） was more common. The frequency of occurrence of SMI was obviously higher than those of symptomatic ischemia. From group I to group II and to group m, The frequency and duration of episodes of SMI and the grade of ST segment depression increased gradually. The frequency of SMI reacjed highest between 6 a. m. to 12 a. m in three groups. It was more frequent during the day than at wight and there was significant difference in occurrence between group I and m 〈 P 〈 0.05）. Conclusions SMI has a high prevalence in old female patients with the insight into mechanism and advanced treatment of CAD. Many of them have no angina in daily life, but they still are the subjects with high cardiovascular risk. It has been demonstrated that SMI has the same clinical significance as symptomatic myocardial ischemia. And SMI was more obvious in the CAD with hypertension and type 2 diabetes mellitus. Studies have shown that dynamic electrocardiogram was a good and important monitoring method of SMI in the old women.