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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 investigate the clinical features of asymptomatic myocardial ischemia (SMI) in elderly patients with coronary heart disease. Methods 48 cases of elderly patients with coronary heart disease in 109 cases of SMI and 28 cases of middle-aged patients with coronary heart disease 30 times SMI. Results The incidence of SMI in elderly patients with coronary heart disease was higher than that in middle-aged patients. The most frequent episode occurred at 9-11am in the morning. The peak of the episode was consistent with the peak plasma concentration of catecholamines, which was related to the decrease of myocardial blood supply. The maximal heart rate and average heart rate of elderly patients with coronary heart disease were lower than those of middle age group, and the detection rate of arrhythmia was higher than that of painful myocardial ischemia, suggesting that exercise was not the main cause. SMI could induce arrhythmia. Conclusions The clinical treatment of angina pectoris in patients with coronary heart disease can not be determined and prognosis, and timely detection and improvement of myocardial ischemia, reduce arrhythmia, to prevent sudden death and myocardial infarction has an important clinical significance.