目的 评价动态心电图(DCG)对老年冠心病患者无症状性心肌缺血(SMI)及相伴发的心律失常的诊断价值.方法 回顾性分析66例临床诊断为冠心病的老年患者DCG监测结果及临床资料,评价SMI发作特点及与年龄的关系;SMI时ST-T改变幅度、持续时间与相关心律失常的关系;受累导联与冠状动脉造影结果相关性分析.结果 66例患者中48例出现SMI,共计218阵SMI发作;上午6:00至12:00SMI的发作频率最高有110阵(50.5％);SMI发作快频率依赖者32例(66.7％),慢频率依赖者5例(10.4％);SMI发作伴发心律失常33例,检出率79.6％;随年龄增长SMI发生率增高,年龄65～75岁患者中发生118阵,(4.3±2.9)次/人,年龄75～85岁患者中SMI发作97阵,(5.2±2.9)次/人.结论 SMI是老年冠心病常见的表现形式,动态心电图能及早检出SMI的存在及其伴发的心律失常,利于评估猝死风险,具有独特的应用价值.%Objective To assess the diagnosis value of 24-hour dynamic electrocardiogram (DCG) on silent myocardial ischemia (SMI) and arrhythmias in elderly patients. Methods Sixty-six continuous elderly patients with coronary heart disease were enrolled, and all of the patients finished the DCG monitors and coronary artery graph or CT examination. The characteristics of SMI, the relationships between SMI and age, involved electrocardiogram leads and coronary angiogram were analyzed. We also evaluated the effects of SMI duration and ST segment depression on the related arrhythmias. Results SMI were found in 48 of 66 patients, and 218 transient SMI attacks were recorded totally. The highest frequency of SMI appeared between 6:00 and 12:00 (110/218, 50.5%). The SMI in 32 patients (32/48, 66.7%) were fast rate dependent and 5 (5/48, 10.4%) were slow rate dependent. Arrhythmias were detected in 38 patients (79.6%). Morbidity of SMI increased with age. One hundred and eighteen transient SMI attacks were recorded in patients aged 65 to 75 years, (4.3±2.9) times per person. Ninety-seven transient SMI attacks were recorded in patients aged 75 to 85 years, (5.2±2.9) times per person. Conclusion SMI is common in elderly patients with coronary heart disease. DCG plays an important role in diagnosing SMI and arrhythmias, which facilitates the evaluation of the risk of sudden death.
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