心肌桥患者平板运动试验分析  

Treadmill exercise test in patients with coronary artery myocardial bridging

作　　者：万进[1] 李七一[1] 王光耀[2] 孙轶秋[1] 方祝元[1] 唐蜀华[1] 杨宗美 章亚成[1] 

机构地区：[1]江苏省中医院心内科,南京210029 [2]南京中医药大学基础医学院 [3]南京市秦淮医院内科

出　　处：《中华心血管病杂志》2012年第7期593-596,共4页Chinese Journal of Cardiology

摘　　要：目的探讨心肌桥患者平板运动试验（TET）时的心电图变化特点和临床意义。方法回顾性分析2003年1月至2010年12月收治的156例心肌桥患者的临床资料。将患者分为吸烟组（68例）和非吸烟组（88例）。研究TET时的心肌缺血情况，同时采用直线相关分析，研究冠状动脉造影显示的心肌桥长度与心肌缺血、运动时间的关系。结果（1）单发性心肌桥154例（99％），其中位于左前降支146例（94％），右冠状动脉8例（5％）；双支心肌桥2例（1％）。1级狭窄16例（10％），2级狭窄108例（69％），3级狭窄32例（21％）。心肌桥长度在4～40mm之间，其中〈10mm40例（26％），11～20mm4．8例（31％），21～30mm44例（28％），331mm24例（15％）。（2）156例心肌桥患者TET阳性64例（141％），其中吸烟组39例（57％，39／68），非吸烟组25例（28％，25／88），吸烟组TET阳性率显著高于非吸烟组（P〈0．01）。（3）心肌桥长度与ST段下移呈正相关（r=0．723，P〈0．01），与运动时间呈负相关（r=-0．828，P〈0．01）；心率与ST段下移呈正相关（r=0．368，P〈0．01）。结论TET可评估心肌桥患者的心肌缺血，心肌桥长度与心肌缺血和运动时间相关。吸烟者缺血发生率较高，应该控烟和戒烟。Objective To observe treadmill exercise test （TET） characteristics in patients with myocardial bridging（MB）. Methods TET results from January 2003 to December 2010 were retrospectively analyzed in 156 patients with confirmed MB diagnosis. MB patients were divided into smoking group （68 cases） and non-smoking group（88 cases）. Coronary angiography results were used to analyze the relations between MB length, myocardial ischemia and exercising duration. Results （ 1 ） MB was documented on two coronary arteries in 2 patients （1%）, MB was detected in single artery in 154 patients （99%）, of whom 146 cases were located at left anterior descending artery, 8 cases were located at right coronary artery. The degree of narrowing of MB was graded 1 （ less than 50% ） in 16 patients （ 10% ）, grade 2 （50% to 75% ） in 108 patients （69%） and grade 3 （greater than 75% ） in 32 patients （21%）. The length of MB ranged between 4 to 40 mm, MB length was less than 10 mm in 40 patients （26%） , between 11 to 20 mm in 48 patients（31% ）, between 21 to 30 mm in 44 patients（28% ）, greater than 31 mm in 24 patients（ 15% ）. （2） TET positive rate was 41% （64/156） and the TET positive rate was significantly higher in smoking group than in non-smoking group [57% （39/68） vs. 28% （25/88, P 〈0. 01） ]. （3） The length of MB was positively related Lo the ST-segment depression （ r = 0. 723, P 〈 0. 01 ） and negatively related to exercising duration （ r = - 0. 828, P 〈 0. 01 ）. Heart rate was positively related to the ST-segment depression （ r = 0. 368, P 〈 0. 01 ）. Conclusions TET may serve as a good test to assess myocardial ischemia in patients with MB. The length of MB is positively related with myocardial ischemia and negatively related with exercising duration. Smoking might increase myocardial ischemic incidence in MB patients, MB patients should be advised to stop smoking.

关 键 词：心肌桥 运动试验 吸烟 

分 类 号：R654.2[医药卫生—外科学]