Med. Klinik II, Klinikum Coburg, Coburg, Germany.
Int J Cardiol. 2011 May 19;149(1):63-7. doi: 10.1016/j.ijcard.2009.11.046. Epub 2010 Jan 6.
Elderly patients tend to seek later for medical help during myocardial infarction. This may be caused by impaired pain perception with ageing. The aim of our study was to prospectively evaluate age-dependent differences in pain perception during temporary induced coronary ischemia.
In 102 patients (68 male, age 68±11 years) undergoing percutaneous coronary intervention, ischemia was induced by balloon inflation for up to 120 s. Time to onset of perceived pain, pain characteristics and pain severity (0=no pain, 100=worst pain possible) was registered. This was repeated twice to evaluate ischemic preconditioning. A 12 lead ECG-tracing was simultaneously recorded. Patients were divided by their median age into 2 groups with comparable demographics: ≤69 years (group 1) and >69 years (group 2).
Group 1 patients demonstrated earlier onset of pain (most apparent during the second inflation: 31±15 s vs. 46±26 s; p<0.001), and greater pain severity (inflation #1: 64±21 vs. 51±25 [p=0.017]; #2: 66±23 vs.52±27 [p=0.008]; #3: 63±23 vs. 54±24 [p=0.085]). ST-changes did not differ (0.24±0.10 vs. 0.20±0.14, [p=0.18]; 0.27±0.17 vs. 0.20±0.14, [p=0.11]; 0.19±0.13 vs. 0.16±0.09; [p=0.32]). Time from occlusion to onset of ECG changes did not differ between the groups, but increased with repetitive inflations (inflation #1: 29±11 s vs. 29±11 s; #2: 31±14 vs. 33±11; #3: 39±21 vs. 40±15 s [increase p=0.017; p<0.001]).
These data suggest that the perception of pain from myocardial ischemia in the elderly is significantly less severe and delayed compared to younger patients.
老年患者在心肌梗死时往往会较晚寻求医疗帮助。这可能是由于随着年龄的增长，疼痛感知能力下降所致。我们的研究目的是前瞻性评估临时诱导性冠状动脉缺血期间与年龄相关的疼痛感知差异。
在 102 名接受经皮冠状动脉介入治疗的患者（68 名男性，年龄 68±11 岁）中，通过球囊充气诱导缺血，持续时间长达 120 秒。记录疼痛开始的时间、疼痛特征和疼痛严重程度（0=无痛，100=最痛）。这重复了两次以评估缺血预处理。同时记录 12 导联心电图。根据中位年龄将患者分为两组，两组具有可比的人口统计学特征：≤69 岁（第 1 组）和>69 岁（第 2 组）。
第 1 组患者疼痛发作较早（第二次充气时最明显：31±15 秒 vs. 46±26 秒；p<0.001），疼痛程度更严重（充气#1：64±21 vs. 51±25 [p=0.017]；#2：66±23 vs. 52±27 [p=0.008]；#3：63±23 vs. 54±24 [p=0.085]）。ST 变化无差异（0.24±0.10 vs. 0.20±0.14，[p=0.18]；0.27±0.17 vs. 0.20±0.14，[p=0.11]；0.19±0.13 vs. 0.16±0.09；[p=0.32]）。两组之间从闭塞到心电图变化开始的时间没有差异，但随着重复充气而增加（充气#1：29±11 s vs. 29±11 s；#2：31±14 vs. 33±11；#3：39±21 vs. 40±15 s [增加 p=0.017；p<0.001]）。
这些数据表明，与年轻患者相比，老年患者心肌缺血引起的疼痛感知明显较轻且延迟。
