急性ST段抬高心肌梗死急诊冠脉造影正常患者的临床分析  

Acute ST-Segment Elevation Myocardial Infarction in Patients with Angiographically Nomal Coronary Arteries during the Emergency Treatment:Clinic Information and Follow-up Results

作　　者：马利祥[1] 王庆胜[1] 张双月[1] 孟晓京[1] 王文广[1] 汤秀英[1] 任琳[1] 杨新春[2] 

机构地区：[1]河北医科大学附属秦皇岛市第一医院心脏监护室,河北省秦皇岛市066000 [2]首都医科大学附属北京朝阳医院心脏中心

出　　处：《中国全科医学》2011年第26期3021-3022,共2页Chinese General Practice

摘　　要：目的探讨急性sT段抬高心肌梗死急诊冠脉造影正常患者的治疗及预后。方法选择2006年9月-2009年4月652例急性ST段抬高心肌梗死患者造影结果正常的26例，回顾性分析26例患者的临床特点、治疗、随访情况及预后。结果626例急性sT段抬高心肌梗死患者行急诊经皮冠状动脉介入治疗，而冠脉造影正常的26例患者行内科治疗，出院后随访5—12个月，平均（8．5±1．1）个月。住院期间有3例发作心绞痛，1例ST段再次抬高，给予扩冠、抗凝、降脂治疗后，病情逐渐平稳。因ST段抬高心肌梗死再住院2例，但复查造影及血管内超声（IVUS）检查结果均正常。患焦虑症2例，22例患者院外随访无再发心绞痛，其中8例需钙拮抗剂治疗，其余继续口服β-受体阻滞剂、硝酸酯及阿司匹林。结论急性ST段抬高心肌梗死急诊冠脉造影正常患者存在不同程度的冠状动脉痉挛及微循环功能障碍，需标准的抗栓治疗及其他相关治疗，以防心血管意外。Objective To explore the treatment and prognosis of acute ST- segment elevation myocardial infarction patients with normal findings during emergency angiography. Methods Twenty - six patients with normal angiography findings from 652 continuous patients with Acute T - segment elevation myocardial infarction from Sep. 2006 to Apr. 2009 were enrolled, with their clinical features, treatment and prognosis retrospectively analyzed. Results Of the 652 patients, emergency - PCI was performed in 626 cases and the other 26 cases with normal angiography findings underwent medical treatment. Follow - up after discharge lasted for 5 ~ 12 （8. 5± 1.1 ） months. Unstable angina pectoris （UAP） were observed in 3 cases and ST elevation in 1 case, which were stabilized after enlargement of the coronary arteries, anticoagulation, and lipids reducing. Two cases were re- hospitalized for ST - elevation who showed normal angiography and intravenous ultrasound （IVUS） findings, Two cases devel- oped anxiety. Twenty - two cases were UAP - free during the follow - up after discharge, though 8 of them were on calcium chan- nel blockers treatment and others were on adrenergic receptor blockers, nitric ether, or aspirin. Conclusion Microvascular dys- function or coronary spasm exist in acute ST - segment elevation myocardial infarction patients with normal findings during emer- gency angiography. Standard anticoagulation and other treatment are necessary among these patients to prevent cardiovascular e- vents.

关 键 词：心肌梗死 冠状血管造影术 随访研究 

分 类 号：R542.22[医药卫生—心血管疾病]