冠脉造影联合动态心电图监测在老年冠心病患者诊断中的价值

目的探讨冠脉造影联合动态心电图监测在老年冠心病诊断中的临床应用价值。方法选取来我院进行诊治的以胸闷、胸痛症状为主的拟诊为冠心病的老年患者76例，所有患者均采取冠脉造影联合动态心电图监测的方式进行诊断。结果76例患者中，60例患者的冠脉造影结果为阳性，16例患者的冠脉造影结果为阴性；56例患者的动态心电图监测结果为阳性，20例患者的动态心电图监测结果为阴性。以冠脉造影阳性结果来判断患者为冠心病，则动态心电图监测对老年患者冠心病诊断的敏感性为73．7％（56／76），特异性为26.3％（20／76）。患者的冠状动脉病变程度和动态心电图持续性ST段低压的阳性率不存在显著关系（P〉0．05）。结论单纯采用动态心电图监测对老年冠心病的诊断并没有太高的应用价值，笔者建议，在临床中应用持续性ST段压低进行冠心病诊断时，需格外谨慎，综合多方面的情况进行诊断，必要时给予冠脉造影进行确诊。

The Value of Diagnosis of CHD by Coronary Angiography Combined with Holter Monitoring

Objective To evaluate coronary angiography combined with holter monitoring clinical value in the diagnosis of coronary heart disease in the elderly. Methods 76 patients with chest distress and chest pain suspected as CHD in our hospital were diagnosed by coronary angiography combined holter monitoring. Results In 76 cases, 60 patients were positive on coronary angiography, 16 patients were negative; 56 patients were positive on holter monitoring results, 20 patients were negative. In order to determine the positive results of coronary angiography in patients with coronary heart disease, the sensitivity ofholter monitoring in elderly patients with coronary heart disease diagnosis was 73.7% （56/76）, specificity was 26.3% （ 20 / 76 ） . The difference of positive rates between coronary angiography and holter monitoring was no statistically significant （P〉 0.05）. Conclusions Holter monitor did not have good application value for the diagnosis of CHD. I suggested that the application of persistent ST-segment depression on diagnosis of CHD should be particularly careful. It needs consider many conditions for diagnosis and the coronary angiography could be used when necessary.