心脏变时功能不全对诊断冠心病作用.docVIP

心脏变时功能不全对诊断冠心病作用【摘 要】 目的 探讨平板运动试验中心脏变时功能不全对诊断冠心病的作用。方法 选择疑诊冠心病患者51例，行平板运动试验和冠状动脉造影检查，得出冠心病组、非冠心病组。计算运动后1 min心率恢复值及心率储备率并进行比较，利用此两种变时性指标作为诊断冠心病的标准，与传统的ST段标准比较。结果 冠心病组的患者运动后1 min心率恢复值及心率储备率均低于非冠心病组。以此两种变时功能不全的指标作为诊断冠心病的标准，与传统的ST段标准相比，其敏感性差异无统计学意义，特异性明显提高。结论 运动试验中心脏变时功能不全可作为诊断冠心病的指标。 ?【关键词】 平板运动试验；变时功能不全；冠心病 The diagnostic value of chronotropic incompetence for coronary artery diseaseZHANG Hong-yu，HE Zhi-xiang，XIAO Hong-wan．Department ofElectrodiagnosis，Fengtian Hospital Affiliated to Shenyang Medical College，Shenyang 110024,China?【Abstract】 Objective To investigate the value of the chronotropic incompetence (CI) for diagnosing coronary artery disease(CAD) during treadmill exercise test (TET)．Methods 51 patients suspected for CAD underwent examinations of both TET and coronary angiography (CAG)．The patientswere divided into CAD group and non- coronary artery disease (NCAD) group based on the results of CAG．Heart rate recovery at 1 minute after exercise (△HR1)and the ratio of heart rate reserve (HRR) between two groups were calculated andcompared．The Sensitivity and specificity between the two indexs of the chronotropic incompetence and ST segment criteria to diagnose CAD were compared．Results Heart rate recovery at 1 minute after exercise and the ratio of heart rate reserve of CAD group were lower than that of NCAD group．2 diagnostic methods had the same sensitivity but the former had highter specificity．Conclusion The chronotropic incompetence can be one index of diagnosing CAD during TET． 【Key words】 Treadmill exercise test;Chronotropic incompetence;Cornonary artery disease 心脏的变时功能是指人体在运动时，或在各种生理及病理因素的作用下，心率能够跟随机体代谢需要的增加而适宜增加的功能。人体运动时或在各种生理和病理因素作用下，心率不能随着机体代谢需要的增加而增加，并达到一定程度时称为心脏变时功能不全[1]。平板运动试验是临床诊断冠心病常用的检查方法，其中ST段改变为使用最多的诊断指标，本文以平板运动试验中运动后1 min心率恢复异常及心率储备率异常作为变时功能不 全的指标，探讨其对冠心病的诊断作用。 1 对象与方法 1．1 对象 选择我院2004年3月至2007年3月临床怀疑为冠心病的患者51例，2周内先后行平板运动试验与冠状动脉造影检查，其中男38例，女13例，年龄38～71岁，平均（53．1±8．7）岁。所有患者均排除急性或陈旧性心肌梗死、完全性左束支传导阻滞、预激综合征、心房颤动、器质性心脏瓣膜病、心肌病、电解质紊