【摘要】 目的应用心脏远程监护技术分析静息性心肌缺血的冠状动脉痉挛和冠状动脉严重狭窄心肌耗氧量增加两种机制各占的比例,统计静息性心肌缺血在不同人群中的发病率。方法查阅患者病历记录,根据冠状动脉造影结果及冠状动脉成形术结果筛选入选患者,查阅入选患者心脏远程监护记录及动态心电图诊断报告,计算静息性心肌缺血两种机制各占的比例及静息性心肌缺血在不同人群中的发病率,并作统计学分析。结果冠心病患者静息性心肌缺血发生率≥21.3%,冠状动脉有一定程度狭窄,但未达到冠心病诊断标准患者静息性心肌缺血发生率≥58.3%(P<0.05)。冠状动脉痉挛在所有发生静息性心肌缺血的机制中所占比例≥73.3%,非冠状动脉痉挛的原因所占比例≤26.7%(P<0.05)。结论冠状动脉造影可以鉴别诊断导致静息性心肌缺血的冠状动脉痉挛和冠状动脉狭窄心肌耗氧量增加的两种机制;静息性心肌缺血发生机制中冠状动脉痉挛所占的比重大;冠状动脉有一定程度的狭窄但未达到冠心病诊断标准的患者比冠心病患者更易发生静息性心肌缺血;心脏远程监护技术的连续监测对于静息性心肌缺血的诊断具有重要意义。更多还原

【Abstract】 Objective To distinguish two mechanisms of resting myocardial ischemia-coronary artery spasm and other causes,and determine the incidence of each mechanism in different coronary atherosclerosis(AS)populations with a remote heart monitoring system.Methods All the patients who underwent the coronary arteriography or Computed Tomography of coronary arteriography(CTA),as well as Holter or iHolter,were enrolled in the remote heart monitoring center from January 2009 to December 2010.All patients′ records and reports of the Holter and iHolter were reviewed,and all analyses were performed with the statistical software program SPSS version 16.0.Results The incidence of resting myocardial ischemia was more than 21.3% in patients diagnosed with coronary artery disease by coronary arteriography or CTA,while the incidence was more than 58.3%(P<0.05) in patients who only showed mild stenosis in CTA or with negative coronary arteriography.Analyzing the etiologies of the resting myocardial ischemia,coronary artery spasm accounted for more than 73.3%,while the other causes only accounted for less than 26.7%(P<0.05).Conclusions Coronary arteriography can be used to distinguish the two mechanisms of resting myocardial ischemia.And coronary artery spasm is the chief mechanism of resting myocardial ischemia.Resting myocardial ischemia can easily happen in the patients only showing mild stenosis in CTA or with negative coronary arteriography.It is very important to monitor resting myocardial ischemia with the remote heart monitoring system.更多还原