24h动态心电图对冠心病无症状心肌缺血患者早期诊断的临床意义

姜姝婧 阎振红 鄂震

[摘要] 目的 探討24 h动态心电图监测对冠心病无症状心肌缺血患者早期诊断的临床价值。 方法 随机抽取2016年12月～2018年12月期间在我院治疗的冠心病患者150例作为临床观察对象，进行24 h动态心电图监测，根据患者的临床症状分为观察组（患者为冠心病无症状心肌缺血，75例），对照组（患者为冠心病有症状心肌缺血，75例）。对比分析两组患者24 h动态心电图中ST 段下移过程的心率变化、ST 段下降情况、心肌缺血的检出率。 结果 入组患者中观察组平均心率（75.18±12.14）次/min、ST段下移心率（75.68±12.37）次/min，均低于对照组平均心率（82.38±13.21）次/min、ST段下移心率（83.06±11.84）次/min，观察组ST 段下降情况（2.03±0.31）mm较对照组（1.81±0.43）mm下降明显，观察组心肌缺血的检出率（78.67%）高于对照组（28.00%），差异均有统计学意义（P<0.05）。 结论 由于冠心病患者心血管组织发生病理性改变，心肌缺血、供氧不足导致心脏机能的不断退化，临床上给予冠心病无症状心肌缺血患者24 h动态心电图监测对其早期诊断效果较好，心肌缺血诊断的准确性好，且该诊断方案安全性高相对无创、快速、经济实惠，具有较高的临床价值。

[关键词] 24 h动态心电图;冠心病;无症状心肌缺血;早期诊断;ST 段下降

[中图分类号] R541.4          [文献标识码] A          [文章编号] 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.