动态心电图QTc间期变化对老年患者无症状性心肌缺血的诊断价值  

The value of QTc interval change on dynamic electrocardiography in the diagnosis of silent myocardial ischemia in elderly patients

作　　者：尹帅 陈晨 尹春彪 舒适[3] 姚明明 张明 YIN Shuai;CHEN Chen;YIN Chunbiao;SHU Shi;YAO Mingming;ZHANG Ming(Department of Critical Care Medicine,Hangzhou Cancer Hospital,Hangzhou 310001,China;不详)

机构地区：[1]杭州市肿瘤医院重症医学科,310001 [2]马鞍山市人民医院心血管内科 [3]马鞍山市人民医院重症医学科 [4]马鞍山市人民医院急诊科

出　　处：《心电与循环》2022年第3期268-271,278,共5页Journal of Electrocardiology and Circulation

摘　　要：目的探讨动态心电图QTc间期变化诊断老年无症状性心肌缺血的价值。方法选择2018年2月至2020年5月马鞍山市人民医院高度怀疑为无症状性心肌缺血的老年患者150例,行冠状动脉(下称冠脉)造影检查,根据造影结果,93例确诊冠脉明显狭窄(冠脉狭窄≥50%,观察组),57例无明显狭窄(冠脉狭窄<50%,对照组),比较两组患者在基线状态及ST段严重压低时的动态心电图参数,并作组间比较。结果ST段基线时,观察组与对照组的P波时间、PR间期、ST段时间、QRS时间、QT间期、QTc间期比较,差异均无统计学意义(均P>0.05)。ST严重压低时,观察组的QT间期、QTc间期和ST段时间均高于对照组,差异均有统计学意义(均P<0.05)。观察组患者在ST段严重压低时的QTc间期长于ST段基线时,差异均有统计学意义(t=-4.879,P<0.05),对照组ST段严重压低、ST段基线时QTc间期比较,差异无统计学意义(P>0.05)。结论无症状老年人动态心电图ST压低伴QTc延长提示存在冠脉明显狭窄。Objective To explore the value of QTc interval change on Holter eletrocardiography in the diagnosis of silent myocardial ischemia in elderly patients.Methods One hundred and fifty elderly patients with high suspicion of silent myocardial ischemia were selected from February 2018 to May 2020 in Maanshan People’s Hospital and underwent coronary angiography.Significant coronary stenosis was detected in 93 patients(the degree of coronary artry stenosis greater than or equal to 50%,observation group)and not in 57 patients(the degree of coronary artry stenosis less than50%,control group).A comparison was performed between dynamic ECG parameters measured at baseline and in severe ST depression and between the two groups.Results P wave width,PR interval,ST segment duration,QRS width,QT,and QTc at baseline were not significantly different between the two groups.The QT,QTc and ST segment duration were significantly higher in severe ST depression than at baseline(all P<0.05).QTc was significantly longer in severe ST depression than at baseline in the observation group(P<0.05).There was no significant difference between QTc at baseline and in severe ST depression in the control group.Conclusion ST depression with QTc prolongation on dynamic ECG predicts significant coronary stenosis in asymptomatic elderly.

关 键 词：动态心电图 QTC间期 诊断 冠心病 

分 类 号：R541.4[医药卫生—心血管疾病] R540.41[医药卫生—内科学]