非ST段抬高型心肌梗死合并急性冠状动脉闭塞患者临床特征分析  

Clinical characteristics analysis of patients with non-ST-elevation myocardial infarction complicated with acute coronary occlusion

作　　者：孙金刚[1] 张丽娟[1] 王志胜[2] 方冬平[2] 

机构地区：[1]山东省临沂市沂水中心医院心内科,276400 [2]首都医科大学附属北京安贞医院心内科 北京市心肺血管疾病研究所,100029

出　　处：《中国医药》2016年第12期1761-1765,共5页China Medicine

基　　金：北京市科技计划（Z131107002213072）

摘　　要：目的 分析非ST段抬高型心肌梗死（NSTEMI）合并急性冠状动脉闭塞（ACO）患者的临床特征。方法 回顾性分析2015年1—12月于首都医科大学附属北京安贞医院接受心脏导管介入治疗的77例 NSTEMI患者的病历资料。根据是否合并ACO将NSTEMI患者分为无ACO组（43例）和合并ACO组（34例）。所有患者接受心电图检查心肌缺血情况，接受经胸超声心动图（TTE）检查左心室收缩功能和心肌运动异常部位；所有患者行冠状动脉造影和血运重建术。比较2组的一般资料、冠状动脉病变部位、手术情况及心电图和TTE检查结果。结果 合并ACO组患者的年龄小于无ACO组［（65±10）岁比（68±10）岁］，差异有统计学意义（P〈0.05）。合并ACO组的大隐静脉桥病变率、冠状动脉狭窄程度和裸金属支架置入率明显高于无ACO组患者［14.7%（5/34）比2.3%（1/43）、100%（100%，100%）比90%（90%，99%）、41.2%（14/34）比7.0%（3/43）］，左主干病变率、前降支病变率和门球时间明显低于无ACO组［0.0%（0/34）比9.3%（4/43）、14.7%（5/34）比25.6%（11/43）、120（64,159）min比240（76,388）min］,差异均有统计学意义（均P〈0.05）。心电图检查提示合并ACO组的前壁心肌缺血发生率明显低于无ACO组［（17.6%（6/34）比39.5%（17/34）］，差异有统计学意义（P〈0.05）。结论 临床上NSTEMI是否合并ACO不易鉴别，合并ACO患者年龄较小，心肌梗死发生距接受冠状动脉介入治疗的时间较短，下壁和后壁心肌缺血相对较为多见。Objective To analyze the clinical characteristics of non-ST-elevation myocardial infarction（NSTEMI） complicated with acute coronary occlusion（ACO）. Methods Totally 77 patients with NSTEMI who had coronary intervention treatment from January to December 2015 in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed, including 34 patients complicated with ACO and 43 patients without ACO. All patients had electrocardiography, transthoracic Doppler echocardiography, angiography and revascularization. General clinical data, operation data, coronary lesion location, myocardial ischemia condition, left ventricular systolic function and abnormal myocardial motion were analyzed. Results Average age of patients with ACO was significantly lower than that of patients without ACO[（65±10）years vs （68±10）years]（P〈0.05）. Saphenous vein graft lesion rate, coronary artery stenosis degree and bare metal stent implantation rate in patients with ACO were significantly higher than those in patients without ACO[14.7%（5/34）vs 2.3%（1/43）, 100%（100%,100%） vs 90%（90%,99%）, 41.2%（14/34）vs 7.0%（3/43）]（P〈0.05）; left main coronary artery lesion rate, left anterior descending branch lesion rate and the duration between acute myocardial infarction （AMI） and percutaneous coronary intervention （PCI） in patients with ACO were significantly lower than those in patients without ACO[0.0%（0/34） vs 9.3%（4/43）, 14.7%（5/34） vs 25.6%（11/43）, 120（64,159）min vs 240（76,388）min]（P〈0.05）. Electrocardiogram results showed that anterior wall myocardial ischemia rate in patients with ACO was significantly lower than that in patients without ACO[（17.6%（6/34） vs 39.5%（17/34）]（P〈0.05）. Conclusions The identification of NSTEMI complicated with ACO is challenging; NSTEMI patients with ACO are associated with younger age and shorter duration time between AMI attack and PCI compared to patients without ACO, inferior and posterior wall

关 键 词：非ST段抬高型心肌梗死 冠状动脉闭塞 心电描记术 超声心动描记术 

分 类 号：R542.2[医药卫生—心血管疾病]