餐后无症状性心肌缺血患者的心室晚电位临床分析

目的通过检测餐后无症状性心肌缺血(silent myocardial ischemia,SMI)患者心室晚电位(ventricular late potentials,VLP)以评价其发生心肌梗死或猝死的危险性。方法对56例有餐后SMI的患者作为观察组,在生活指导前后分别于空腹、餐后2小时和运动后进行VLP检查,并与对照组同期非餐后SMI的223例患者进行对比。结果生活指导前,观察组于空腹、餐后2小时和运动后的VLP阳性率均分别为25.0%、28.6%、26.8%,显著高于对照组(10.8%、9.9%、9.4%,差异有统计学意义(P<0.01)。经生活指导后,对照组于空腹、餐后2小时和运动后的VLP阳性率分别下降至5.4%、4.0%、4.5%,差异有统计学意义(P<0.05);而观察组的VLP阳性率无明显变化(P>0.05)。结论餐后SMI患者的VLP阳性率显著高于非餐后SMI患者,推测其在SMI患者中发生心肌梗死或猝死的危险性最高,且一般生活指导并不能降低其危险性。

A clinical analysis on ventricular late potentials in patients with post-meal silent myocardial ischemia

Objectives To evaluate the risk of myocardial infarction or sudden cardiac death in the patients with post-meal silent myocardial ischemia (SMI)by examining their ventricular late potentials (VLP). Methods The fasting,the post-meal (after two hours of post-meal) and the post-exercise VLP were measured in 56 postmeal SMI patients (the observation group) and 223 non-post-meal SMI patients (the control group) before and after the life guidance. Results The rate of positive for the fasting, the post-meal and the post-exercise VLP of the observation group were all much higher than that of the control group before the life guidance (25.0%, 28.6%, 26.8% vs 10.8%, 9.9%, 9.4%, all P<0.01). The rate of positive for the fasting, the post-meal and the post-exercise VLP of the control group after the life guidance were obviously less than that before the life guidance (all P<0.01). But there were not significant difference in the observation group between pre- guidance and post- guidance (all P>0.05).Conclusions The rate of positive VLP of the post-meal SMI patients is much higher than the non-post-meal SMI patients. Then, it is inferred that the risk of myocardial infarction or sudden cardiac death in the patients with post-meal SMI will be the highest. And they could not be cut down only by the life guidance.