冠心病无症状性心肌缺血的动态心电图表现及其诊断价值

目的：应用动态心电图（DCG）检测冠心病（CAD）的无症状性心肌缺血（SMI）,以探讨其发生率、发病规律、病情和预后关系。并由此评价DCG诊断SMI及指导临床治疗的应用价值。方法：采用12导联DCG记录系统，对224例CAD患者连续监测24h，回放分析观察ST段移位值；心肌缺血阈等指标。结果：224例CAD患者中发生心肌缺血204例（91．07％），共检出694次心肌缺血发作，而其中589次为SMI（84．87％）；心肌缺血性ST段下移发作以6：00～12：00时最为频繁。而0：00～6：00时出现最少；夜间缺血ST段下移持续时间延长，心肌缺血阈变异性值增高；心率越快，诱发的心肌缺血越严重，ST段下移越明显。结论：DCG是较理想的诊断SMI的非创伤性辅助检查方法。

Appearance and diagnostic value of dynamic electrocardiogram on silent myocardial ischemia

Objective： To evaluated the value of dynamic electrocardiogram （DCG） diagnosing silent myocardial ischemia （SMI） of coronary artery disease （CAD） and to explore its rules and mechanism. Methods： A total of 224 CAD patients were examine by 12--lead DCG for 24 h, observed the ST segment, the duration of every ischemia episode, myocardial ischemic threshold etc. Results： A total of 694 ischemic episodes happened in 224 CAD patients; of these 84.87% isehemic episodes were SMI. Most frequent time happened myocardial ischemie was 6 ： 00 to 12 ： 00 AM, while least frequent time happened myocardial ischemic was 0：00 to 6 ： 00 AM. The duration of ischemic ST segment depression and myocardial ischemic threshold variability increased in night. The heart rate faster, the myocardial ische- mia and ST segment depression more serious. Conclusion： Dynamic electrocardiogram is a better and no--invasivc diagnosis method for SMI.