老年人713例动态心电图心律失常及心肌缺血的特征及临床分析

目的分析老年人动态心电图(DCG)心律失常及心肌缺血的特征。方法 713例老年患者均先作12导联心电图检查,然后采用美国PI 12导联动态心电分析系统,作24 h DCG监测并详细记录活动情况及临床症状。经计算机处理回放分析、经人机对话方式,进行编辑和总结。结果70岁以上老年患者心律失常发生率明显增高,说明年龄与心律失常的发生有关。老年人心律失常以房性心律失常最多见,检出率为93.41%。室性心律失常检出率为63.39%。窦性心律失常检出率为23.98%。传导阻滞检出率为15.29%。其中房性期前收缩检出率最高,其余依次为室性期前收缩、窦性心动过缓、房性心动过速。232例有缺血性ST-T改变,发生率为32.54%,无症状心肌缺血(SMI)远多于有症状心肌缺血。结论 动态心电图能捕捉一过性、间歇性的恶性的心电变化,老年人行DCG检查,可及早发现各种恶性心律失常、心肌缺血及窦房结病变。     

动态心电图对发作性晕厥、眩晕、心悸患者的监测及临床意义

1981年3～11月,我们对60例发作性晕厥、眩晕及心悸患者进行了动态心电图(简称DCG)监测,发现他们可能与某种心律失常有关。DCG监测检出心律失常占73.3％,而常规心电图(ECG)检查为51.6％,晕厥组以显著窦性过缓为主;眩晕组缓慢性及快速性心律失常的发生率差不多一样;单纯心悸组则以发作性房、室早搏为主,次为短阵的房性及室上性心动过速(各5例)。各组症状与血液动力学的关系研究表明,晕厥组的心排血量及心脏指数明显降低,眩晕组次之,心悸组则仍在正常范围内。     

电话传送心电监护的临床应用与评价

电话传送心电监护(TTM)国内报道较少。为了探讨TTM在临床上的应用价值,采用以色列产的Card Guard 8000 TTM系统对心脏病或疑似心脏病患者实施TTM。结果显示:对有症状(偶发、短暂心悸、胸闷等)的TTM中,异常心电图占74％,有症状TTM正常者占26％,后者经证实为非心源性所致。27例患者同时进行动态心电图DCG检查,TTM与DCG诊断符合率为82％,DCG正常而TTM异常者占18％,对DCG未能检出的心律失常和一过性心肌缺血TTM有较好的补充诊断作用。结论:TTM对心律失常、心肌缺血和心肌梗塞等能及时作出诊断和指导现场救治,对有症状的偶发短暂的心律失常和一过性心肌缺血有独到的诊断价值。效果优于DCG。适于心律失常、心肌缺血的即时心电判定、药物治疗观察病情变化及副作用,指导药物调整。     

老年多发病患者动态心电图特点及治疗探讨

目的分析老年多发病患者动态心电图特点和优化治疗。方法选择2008年6月~2009年7月住本院地方干部病房患者700例,男性506例（72．3％）,女性194例（27．7％）;年龄60～96岁（平均78．1岁）,所患疾病主要为高血压病、冠心病、脑血管病、癌瘤、慢性支气管炎、肺气肿、肺心病、肺炎、糖尿病、前列腺增生等老年多发病中3种以上。全部病例均先作12导联心电图检查,然后用美国MortaraInstrumentIncH—Scribe12＋型动态心电图仪12导监测记录24h心电图。结果室性心律失常554例（79．1％）,Lown3级以上为329例（47．0％）;房性心律失常683例（97．6％）,其中频发房早,成对、短阵房速340例（48．6％）,心肌缺血130例（18．6％）,且多为心肌缺血（SMI）无临床症状。结论老年多发病患者动态心电图特点是两高（心律失常发生率高,恶性室性心律失常高）,两低（心肌缺血检出率低,临床症状出现率低）,胺碘酮有广泛抗心律失常作用,疗效好,促心律失常作用小,可为多种心律失常治疗之首选。     

J波对急性心肌梗死后恶性室性心律失常预测价值的研究

目的 研究急性心肌梗死(AM)后出现J波的患者跨壁复极离散度变化及其与恶性室性心律失常的关系,评价J波预测AM后恶性室性心律失常的临床价值.方法 回顾性分析130例急性ST段抬高型心肌梗死(STEMI )患者的心电图(ECG)及相关临床资料,根据ECG结果 分为J波组(21例)和无J波组(109例),比较两组临床情况、心肌梗死部位、恶性室性心律失常发生率、QT离散度(QTd),T波峰-末间期(TpTe).再将J波组分为恶性室性心律失常亚组(6例)和无恶性室性心律失常亚组(15例),并比较两组的QTd及TpTe ,结果 AM后J波的出现率为16.15%,J波组下壁梗死发生率(52.38%)明显高于无J波组(26.61%,P<0.05),恶性室性心律失常的发生率(28.57)也明显高于无J波组(1.83%,P<0.01),且QTd,TpTc(分别为76±19,121士33ms)较无J波组(分别为47±19,99±26ms)明显延长(P<0.01).与TpTe的正常值(92ms)相比,J波组的TpTe明显延长(P<0.01);J波组发生恶性室性心律失常者的QTd及TpTe(分别为97±15,157±27ms)均比无恶性室性心律失常者(分别为68±13,107±52ms)明显延长(P<0.01).结论 心电图J波提示心室跨壁复极离散度增加,可作为AMI患者恶性室性心律失常的预测指标.出现J波且伴随心室跨壁复极离散度显著增加者为AM后恶性室性心律失常的高危人群.     

稳心颗粒联合美托洛尔治疗室性心律失常疗效观察

目的:观察稳心颗粒联合美托洛尔治疗室性心律失常的临床疗效及不良反应。方法:选择室性心律失常116例,随机分为观察组和对照组各58例。对照组采用口服美托洛尔治疗,每次12.5～25mg,每天2次。观察组在对照组基础上,增加稳心颗粒治疗,每次9g,每天3次。均4周为1个疗程,观察两组治疗前后临床症状、心电图改善情况及不良反应。结果:观察组临床总有效56例(96.6%),对照组43例(74.1%);两组比较,差异显著(P<0.05)。观察组心电图总改善55例(94.3%),对照组45例(77.6%);两组比较,差异显著(P<0.05)。两组均未发生严重不良反应。结论:稳心颗粒联合美托洛尔治疗室性心律失常较单用美托洛尔疗效好,且安全。     

228例老年冠心病患者心室晚电位的临床意义

本文对228例60岁以上老年冠心病患者进行了心室晚电位测定,结果显示冠心病心绞痛伴有室性心律失常组,心室晚电位阳性率高于冠心病心绞痛无室性心律失常组,二组差异显著(P<0.05);心肌梗塞伴有室性心律失常组与心肌梗塞无室性心律失常组相比,晚电位阳性率也有显著差异(P<0.05),前者明显高于后者.其中3例心室晚电位阳性者2例死于室速,1例死于室颤.我们认为心室晚电位可作为致死性室住心律失常或心脏性猝死的预报指标.     

高血压患者同步检测动态血压和动态心电图的初步研究

 目的探讨血压升高及降低与发生心肌缺血、心律失常之间的关系,为临床治疗提供依据.方法56例高血压病患者同步检测24h动态血压(ABP)和动态心电图(DCG),分析其血压升高及降低与发生ST-T改变、心律失常之间的关系.结果(1)60.7%(34例)轻、中度(1、2级)动态高血压和26.8%(15例)ABP升高,64.3%(36例)血压昼夜节律消失,76.8%(43例)呈非杓型ABP曲线;(2)DCG有多种异常改变,以ST-T改变(28.6%、51.8%)和房、室性心律失常(67.9%、37.5%)较多见;(3)ST-T改变和房、室性心律失常与ABP最高值及白昼最低值有显著相关性(P＜0.05或P＜0.01),而与夜间最低值无相关性(P＞0.05),收缩压、舒张压之间无差异.结论本组患者87.5%血压控制不满意,64.3%有心脏等靶器官损害,显示血压升高及白昼血压降低与显著ST-T改变和较复杂房、室性心律之间有顺序或因果关系.     

高原地区高血压病心律失常分析

目的:探讨高原地区原发性高血压心律失常与心肌缺血,左室肥厚,血压水平之间的关系。方法:对住院的405例原发性高血压患者血压水平,心电图,24 h动态心电图,超声心动图等临床资料进行回顾性分析研究。结果:高原地区原发性高血压左室肥厚发生率50.86%,心肌供血不足发生率54.01%,室性心律失常发生率61.23%,房性心律失常发生率81.98%。左室肥厚组室性心律失常的发生率显著高于无左室肥厚组(P<0.01);心肌缺血组发生心律失常较无心肌缺血组有高度显著差异(P<0.01)。结论:高原地区高血压病心律失常的发生与高原地区低氧环境及左室肥厚,心肌缺血,血压水平等综合因素有关。     

36例歼击机飞行员24h动态心电图分析

为了解中国歼击机赠心电活动特点，分析了３６例歼击机飞行员２４ｈ动态心电图（ＤＣＧ），并与５５例正常人ＤＣＧ比较。结果显示：房性心律失常多于室性，房性或室性心律失常均高于正常组，ＳＴ段下移检出率亦高于正常组。     

动态心电图与常规心电图诊断心肌缺血和心律失常临床效果分析

目的评价动态心电图与常规心电图诊断心肌缺血及心律失常的临床效果。方法选取2014年1月-2014年12月在渠县人民医院收治的42例冠心病患者,分别以动态心电图与常规心电图为主要诊断方法,观察2种方法诊断心肌缺血和心律失常的阳性率。结果以动态心电图为主要方法诊断冠心病患者心肌缺血及心律失常阳性率高,差异有统计学意义(P<0.05)。结论以动态心电图为主要方法诊断心肌缺血及心律失常有助于提升整体检出率。     

Prevalence and prognostic significance of silent myocardial ischemia in patients after myocardial infarction

BACKGROUND/AIM: Silent myocardial ischemia (MI) can be detected in subjects with any symptoms, in patients after myocardial infarction and in coronary patients who have episodes of symptomatic, as well as of silent MI. This study was carried out to evaluate the frequency, characteristics and prognostic significance of silent MI detected in stress echocardiography test in patients after myocardial infarction. METHODS: In 210 patients within three months after myocardial infarction exercise test was performed. In those patients with ischemic ST depression on exercise electrocardiogram, in order to confirm MI stress echocardiography was additionally performed. To assess the incidence of major cariovascular events, all the patients were followed at least five years after the first myocardial infraction. RESULTS: Out of 210 patients 88 (42%) had ischemic response during stress echocardiography test. Out of 88 patients with MI 54 (61%) had anginal pain (patients with symptomatic MI), while 34 (39%) were free of symptoms (patients with silent MI). Level of exercise test, heart rate, time to the onset of ST segment depression, and the magnitude of ST segment depression were similar in both subgroups of the patients with MI. Duration of exercise test was longer in patients with silent MI (p < 0.05). Wall motion score index during stress echocardiography was higher in patients with symptomatic MI (p < 0.05). Coronary angiography findings were similar in patients with silent and those with symptomatic MI. During a five-yearsfollow-up period the occurrence of major cardic events (cardiac mortality and recurrent myocardial infarction) was similar in both subgroups of the patients with MI. CONCLUSION: In more than one third of patients after myocardial infarction silent MI during stress echocardiography was detected. The patients with silent ischemia had longer duration of exercise test and smaller wall motion score index on stress echocardiography. There was no difference in coronary angiography finding between patients with silent and those with symptomatic MI. The incidence of major cardiac events during a five- years- follow-up was similar in the patients with silent and those with symptomatic MI.     

变异型心绞痛心律失常特点临床分析

目的：探讨变异型心绞痛(VA)患者，心绞痛发作时伴发各种类型心律失常的临床特点及其发生机制。方法：临床观察88例VA患者，均采用18导联心电图或CM5和CMavF导联系统进行24小时监测(Holter)，记录VA患者心肌缺血时间的长短、伴发心律失常的有无、类型及发作时相，并均行冠状动脉造影检查，明确冠状动脉病变有无以及病变部位。结果：88例VA患者心肌缺血发作时有48例患者发生心律失常，其心律失常的发生率为54．5％。快速性和缓慢性心律失常均有发生；在前壁心肌缺血发作时，室性心律失常多见。其中室性心动过速的患者(9例)，室性期前收缩21例，心室颤动2例。下壁心肌缺血发作时常见缓慢型心律失常；如窦性心动过缓、窦性停搏及房室传导阻滞。48例发生心律失常的患者中，缺血持续时间平均为9．24分钟，而在40例未发生心律失常的患者中，缺血持续时间平均为4分钟；42例患者(87．5％)的心律失常发生在缺血闭塞期，6例患者(12．5％)的心律失常发生在缺血再灌注期。结论：①VA可并发闭塞期和再灌注期心律失常，但以前者为多；②右冠状动脉痉挛引起下壁心肌缺血时，易造成缓慢性心律失常；而左前降支冠状动脉痉挛引起前壁心肌缺血时，则易发生快速性心律失常和或严重室性心律失常；③VA发作时心肌缺血持续时间的长短与心律失常发生率具有相关性，且直接影响其预后。     

肥厚型心肌病合并心律失常临床特征及治疗

目的探讨肥厚型心肌病合并心律失常的临床特征及治疗方法。方法回顾性分析2000年9月至2016年7月经心脏超声或左室造影及心电图或动态心电图证实为肥厚型心肌病(HCM)合并心律失常的105例患者临床特征及治疗方法。结果 105例患者分为肥厚型非梗阻性心肌病组(HNCM)42例,肥厚型梗阻性心肌病组(HOCM)41例,心尖肥厚型心肌病组(AHCM)22例。3组患者临床特征差异无统计学意义(P>0.05)。HCM合并心律失常类型包括窦性心动过缓、心房扑动、心房颤动、房室传导阻滞、频发房性早搏、频发室性早搏、非持续性室性心动过速、心室颤动。3组不同心律失常类型中,均为心房颤动发生率最高,分别为38.1%、63.4%及50.0%。HOCM组12例患者行经皮间隔心肌消融术,4例患者行外科肥厚心肌切除术。HNCM组4例患者行永久起搏器植入术。HOCM组2例患者因心室颤动植入单腔植入型心律转复除颤器。HNCM组、HOCM组及AHCM组分别有7例、2例及2例患者行射频消融术。出院后随访3~14个月,平均(8±3)个月,患者均存活,临床症状均明显缓解。结论 HCM合并心律失常的患者,选择适当的治疗方法,可取得良好的疗效。     

Prognostic significance of silent ischemia

This study examined the prognostic predictors in 521 patients with angiographic evidence of coronary artery disease (CAD). All patients underwent exercise single-photon emission computed tomographic thallium imaging. The patients were divided into those with symptomatic ischemia defined as reversible thallium defects, S-T segment depression (or both) and angina during exercise (n= 210, group 1), and silent ischemia defined as thallium defects or ST segment depression (or both) but no angina during exercise (n = 311, group 2). During a mean follow-up of 24 ±21 months, there were 30 cardiac events (death or nonfatal myocardial infarction). The extent of CAD (2.0 ±0.8 diseased vessels in group 1 and 2.1 ±0.8 diseased vessels in group 2), the left ventricular ejection fraction, the extent of perfusion abnormality (21% ±11% in group 1 and 24% ±12% in group 2), and the peak heart rate and double product were similar in the two groups. Survival analysis showed no significant difference in the event-free survival in patients with symptomatic or silent ischemia. The 2-year event-free survival rate was 95% in group 1 and 94% in group 2 (difference not significant). The extent of perfusion abnormality and history of diabetes mellitus were the most important predictors of events. Thus the prognosis of medically treated patients with CAD is comparable in those patients with silent or symptomatic ischemia and is dependent on the extent of myocardium at risk rather than presence or absence of angina pectoris during exercise. Presented in part at the Sixty-sixth Annual Scientific Sessions of the American Heart Association, Atlanta, Ga., November 1993.     

运动平板试验诊断无症状心肌缺血的临床价值

 目的 评价运动平板试验（treadmill exercise testing,TET）检出冠心病无症状心肌缺血(slient myocardial ischemia,SMI)的诊断价值。方法 对经动态心电图检查拟诊为SMI患者145例进行TET及冠状动脉造影(coronary angiography,CAG）检查,并以后者作为判定标准,计算TET诊断SMI的敏感性、特异性、准确性指数、阳性预测值及阴性预测值。结果 TET检出SMI的敏感性为89.3%,特异性为67.2%,准确性为80.0%,阳性预测值为78.9%,阴性预测值为82.0%。多支冠脉病变患者的运动平板试验阳性率与单支病变患者的对比差异无统计学意义(P>0.05)。女性运动平板试验假阳率高于男性(P <0.01)。结论 检出SMI的特异性较低,但敏感性较高,能较准确评价SMI 的缺血情况。     

Evaluation of silent myocardial ischemia by exercise radionuclide ventriculography: comparison between patients with and without old myocardial infarction

We evaluated left ventricular systolic function during exercise in patients with silent or symptomatic myocardial ischemia by radionuclide ventriculography (RNV). The subjects consisted of 61 patients who had evidence of myocardial ischemia during exercise RNV defined as positive exercise electrocardiographic changes and angiographically documented coronary artery disease. The patients without angina during exercise (SMI) had less exercise-induced left ventricular systolic dysfunction than patients with angina (CP) (change in ejection fraction during exercise: delta EF; -1 +/- 13 vs -6 +/- 10%, p less than 0.05, systolic blood pressure/end-systolic volume in exercise divided by systolic blood pressure/end-systolic volume in rest: SP/ESV (ex/rest); 1.1 +/- 0.6 vs 0.8 +/- 0.3, p less than 0.05). The 61 patients were divided into two groups, that is, those with and without old myocardial infarction (OMI), and we compared the degree of left ventricular systolic dysfunction during exercise between SMI and CP by RNV in each group. In patients without OMI, SMI had less exercise-induced left ventricular dysfunction than CP (delta EF; 1 +/- 12 vs -10 +/- 8%, p less than 0.01, SP/ESV (ex/rest); 1.1 +/- 0.6 vs 0.7 +/- 0.2, p less than 0.01). However, there were no differences between SMI and CP with OMI. In conclusion, it was thought that SMI without OMI was less degree of myocardial ischemia, and that SMI with OMI was potentially caused by some factors except for the degree of myocardial ischemia.     

218例冠心病患者24小时动态心电图分析

对２１８例冠心病人行２４ｈ动态心电图监测。结果：检出心律失常４１２例次（９２．２５％），常规静息心电图检出心律失常８１例次（３７．１５％），二者有显著差异（Ｐ＜０．０１）；冠心病人常见的心律失常依次为：室性早搏、房性早博、房性心动过速；冠心病心绞痛患者１８７例显示ＳＴ段压低＞１．０ｍｍ，其中心肌缺血７５％不伴有心绞痛发作。提示无症状心肌缺血可作为不稳定型心绞痛发作的一项重要预后指标。