动态心电图监测在无症状心肌缺血诊断中的作用

目的：探讨动态心电图监测在无症状心肌缺血（SMI）诊断中的意义。方法：选取我院2013年1~12月收治的冠心病患者116例,行8-24h动态心电图检查,观察并记录患者心绞痛及ST段压低阵数情况。结果：本组患者共检出心肌缺血97例（83.6%）,缺血性ST段下移共发生1 390阵次,其中有症状心肌缺血共检出200次（14.4%）,ST下移（0.17±0.04）mV;SMI共检出190次（85.6%）,ST段平均下移（0.16±0.07）mV;〉61岁患者SMI发生比例显著高于低于61岁患者（P〈0.05）,SMI发生比例随年龄增长而增高。SMI共检出ST段下移1 190阵次,白天显著高于夜间（P〈0.05）,昼夜间差异具有统计学意义（P〈0.05）。SMI患者18：00~6：00时心肌缺血时间、IV值均显著高于6：00~18：00,两时间段SMI患者ST段压低程度、持续时间及IV值比较均有统计学差异（P〈0.05）。结论：动态心电图监测可明确SMI发病时间段,SMI检出率高,是诊断SMI的有效方法。

Dynamic electrocardiogram monitoring in diagnosis of asymptomatic myocardial ischemia

Objective： To investigate the clinical application of dynamic electrocardiogram monitoring in the diagnosis of asymptomatic myocardial ischemia （SMI）. Methods： A total of 116 patients with coronary heart disease admitted in our hospital from January 2013 to December 2013 were recruited. 8-24 h dynamic electrocardiogram examination was performed. Angi na pectoris status and the times of ST segment pulls down were recorded. Results： A total of 97 cases （83.6%） had myocardial ischemia, and 1 390 times of ischemic ST-segment down was recorded. It included 200 times of symptoms-myocardial ischemia （14.4%）, and ST was declined at （0. 17±0.04） mV; 190 times of SMI （85.6%）, with average declination of （0. 16±0.07） mV; SMI occurrence of patients 〉61 year-old was significantly higher than that 〈61 years old （P〈0.05）, and it was increased with age. In SMI patients, 1 190 times of ST segment declined was recorded, significantly higher than that during the night （P%0.05）. The myocardial ischemia duration and IV during 18：00-6：00 were significantly higher than that during 6：00- 18：00 （P〈0.05）. Conclusions： Electrocardiogram monitoring can detect SMI onset time explicitly with high detection rate, and it is an effective method for diagnosis of SMI.