老年冠心病患者无症状心肌缺血的初步分析  

A Preliminary report on silent myocardial ischemia in aged patients with coronary heart disease

作　　者：吴雅利[1] 雷梦觉[1] 郑培英[1] 

机构地区：[1]江西省人民医院

出　　处：《实用老年医学》1997年第3期117-118,共2页Practical Geriatrics

摘　　要：目的探讨老年冠心病患者无症状心肌缺血（ＳＭＩ）的临床特征。方法应用动态心电图检测４８例老年冠心病患者１０９阵次ＳＭＩ和２８例中年冠心病患者３０阵次ＳＭＩ。结果老年冠心病患者ＳＭＩ发生率高于中年组，以上午９～１１时发作最频，其发作高峰与血浆儿茶酚胺生理高峰浓度时间一致，与心肌供血减少有关。老年冠心病患者发作ＳＭＩ时最大心率和平均心率均低于中年组，而且心律失常检出率高于有痛性心肌缺血时，提示运动不是主要诱因，ＳＭＩ可诱发心律失常。结论临床不能根据冠心病患者心绞痛的有无决定治疗及判断预后，及时发现和改善心肌缺血状态，减少心律失常，对防止猝死和心肌梗塞发生具有重要的临床意义。Objective To study the clinical feature of silent myocardial ischemia(SMI) in aged patients with coronary heart disease(CHD). Methods 109 transient episodes of SMI in 48 aged patients and 30 transient episodes of SMI in 28 pre aged patients were detected by ambulatory electrocardiogram monitoring (AEM). Results The study demonstrated that the aged patients had a higher frequency of SMI than the pre aged patients.The frequency of SMI was the highest between 9 a.m and 11 a.m,which coincided with the peak value of the plasma catecholamine.The maximal heart rate and average heart rate in aged patients were lower than that in pre aged patients at the time of SMI.The frequency of arrhythmia occurring at the time of SMI was higher than that at the time of symptomatic ischemia.This study indicates that exercise is not the major cause leading to SMI but SMI results in arrhythmia.Conclusions The clinical prognosis and treatment can not be determined according to whether angina pectoris is present or not.To detect the myocardial ischemia,improve the blood supply and control the arrhythmia are significant measures for the prevention of sudden death and myocardial infarction.

关 键 词：动态心电图 冠心病 无症状 心肌缺血 心律失常 

分 类 号：R541.4[医药卫生—心血管疾病]