24h動態心電圖對冠心病無癥狀心肌缺血患者早期診斷的臨床意義

姜姝婧 閻振紅 鄂震

[摘要] 目的 探討24 h動態心電圖監測對冠心病無癥狀心肌缺血患者早期診斷的臨床價值。 方法 隨機抽取2016年12月～2018年12月期間在我院治療的冠心病患者150例作為臨床觀察對象，進行24 h動態心電圖監測，根據患者的臨床癥狀分為觀察組（患者為冠心病無癥狀心肌缺血，75例），對照組（患者為冠心病有癥狀心肌缺血，75例）。對比分析兩組患者24 h動態心電圖中ST 段下移過程的心率變化、ST 段下降情況、心肌缺血的檢出率。 結果 入組患者中觀察組平均心率（75.18±12.14）次/min、ST段下移心率（75.68±12.37）次/min，均低于對照組平均心率（82.38±13.21）次/min、ST段下移心率（83.06±11.84）次/min，觀察組ST 段下降情況（2.03±0.31）mm較對照組（1.81±0.43）mm下降明顯，觀察組心肌缺血的檢出率（78.67%）高于對照組（28.00%），差異均有統計學意義（P<0.05）。 結論 由于冠心病患者心血管組織發生病理性改變，心肌缺血、供氧不足導致心臟機能的不斷退化，臨床上給予冠心病無癥狀心肌缺血患者24 h動態心電圖監測對其早期診斷效果較好，心肌缺血診斷的準確性好，且該診斷方案安全性高相對無創、快速、經濟實惠，具有較高的臨床價值。

[關鍵詞] 24 h動態心電圖;冠心病;無癥狀心肌缺血;早期診斷;ST 段下降

[中圖分類號] R541.4 ? ? ? ? ?[文獻標識碼] A ? ? ? ? ?[文章編號] 1673-9701（2019）24-0019-03

[Abstract] Objective To investigate the clinical value of 24 h dynamic electrocardiogram in early diagnosis of asymptomatic myocardial ischemia（SMI） in patients with coronary heart disease. Methods 150 patients with coronary heart disease who were treated in our hospital from December 2016 to December 2018 were randomly selected as clinical observation subjects. They underwent 24-hour Holter monitoring and were divided into observation group（patients with asymptomatic myocardial ischemia，75 cases），and control group（patients with symptomatic myocardial ischemia，75 cases） according to the clinical symptoms of the patients. The heart rate changes in the ST segment decline process， ST segment decline， and the probability of detection of myocardial ischemia were analyzed in the 24-hour ambulatory electrocardiogram of the two groups were compared and analyzed. Results The average heart rate 75.18±12.14）times/min and the heart rate in the ST segment decline（75.68±12.37）times/min in the observation group were lower than the average heart rate（82.38±13.21）times/min， and the heart rate in ST segment decline（83.06±11.84）times/min of the control group. The decrease of ST segment in the observation group（2.03±0.31）mm was significantly lower than that of the control group（1.81±0.43）mm. The detection probability of myocardial ischemia in the observation group was（78.67%）， higher than that of the control group（28.00%）， and the difference was statistically significant（P<0.05）. Conclusion Due to the pathological changes of cardiovascular tissue in patients with coronary heart disease， myocardial ischemia and insufficient oxygen supply lead to the continuous deterioration of cardiac function. Clinically，the 24-hour dynamic electrocardiogram monitoring of patients with asymptomatic myocardial ischemia in coronary heart disease is more effective in early diagnosis，with good accuracy of myocardial ischemia diagnosis. And the diagnosis scheme has high safety and is relatively non-invasive， rapid， and economical， and has high clinical value.