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目的:探讨动态心电图结合冠状动脉造影对无痛性心肌缺血患者的诊断作用。方法:对174例冠心病(CHD)患者给予动态心电图结合冠状动脉造影检查,监测患者心肌缺血发生阵次、每次心肌缺血发作持续时间以及ST段最大下移情况。结果:174例患者中,动态心电图结果显示145例患者ST段压低,29例患者ST段抬高;114例患者为无痛性心肌缺血,大多发作时间为在清晨5:00至上午11:00,58例患者为有症状性心肌缺血;2例患者为急性心肌梗死,其ST段均抬高。113例患者发生室性心律失常,97例患者发生室上性心律失常者,28例患者下出现传导阻滞,其中,47例(27.01%)同时存在室性与室上性心律失常。无痛性心肌缺血患者心肌缺血发作1160阵次,发生于患者心情平静或轻微活动时,持续时间长。有症状性心肌缺血患者心肌缺血发作399阵次,发生于患者情绪激动、劳累、剧烈活动时。结论:动态心电图结合冠状动脉造影检查可对患者心肌缺血的程度、部位、发作频率、持续时间等进行明确诊断,避免误诊的发生率。动态心电图结合冠状动脉造影检查对诊断无痛性心肌缺血,预防心血管疾病具有重要的临床意义。
Objective: To investigate the diagnostic value of Holter combined with coronary angiography in patients with painless myocardial ischemia. Methods: 174 patients with coronary heart disease (CHD) were given dynamic electrocardiogram combined with coronary angiography to monitor the occurrence of myocardial ischemia in patients with each myocardial ischemic attack duration and ST segment maximum down the situation. Results: Of the 174 patients, the results of Holter monitoring showed that ST-segment depression was found in 145 patients and ST-segment elevation was observed in 29 patients. Painless myocardial ischemia occurred in 114 patients, most of which occurred between 5:00 AM and 11: Fifty-eight patients had symptomatic myocardial ischemia; two patients had acute myocardial infarction with elevated ST-segment. Thirteen patients developed ventricular arrhythmias, 97 patients had supraventricular arrhythmias, and 28 patients had conduction block. Of these, 47 (27.01%) had both supraventricular and supraventricular arrhythmias. Myocardial ischemia in patients with painless myocardial ischemia attack 1160 array occurred in patients with calm or mild activity, sustained a long time. Myocardial ischemia in patients with symptomatic myocardial ischemia 399 array occurred in patients with emotional, tired, intense activity. Conclusion: Holter combined with coronary angiography can diagnose the degree, location, frequency and duration of myocardial ischemia in patients with definite diagnosis and avoid the incidence of misdiagnosis. Holter combined with coronary angiography on the diagnosis of painless myocardial ischemia, prevention of cardiovascular disease has important clinical significance.