急性回旋支闭塞的心电图表现及相关临床表现和病变血管特点  

Electrocardiogram perform ance and clinical characteristics in patients with acute occlusion of the left circumflex coronary artery

作　　者：贺威 商丽华 范继红 熊为国 逯春鹏 HE Wei;SHANG Li-hua;FAN Ji-hong;XIONG Wei-guo;LU Chun-peng(Department of Cardiology, Beijng Hua Xin Hospital, The First Affiliated Hospital of Tsinghua University, Beijing 100016, China;Department of Cardiology, Beijing Friendship Hospital, Beijing 101100, China)

机构地区：[1]清华大学第一附属医院北京华信医院心脏中心,北京市100016 [2]首都医科大学附属北京友谊医院通州院区心内科

出　　处：《中国心血管病研究》2019年第8期751-754,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的研究急性回旋支闭塞患者心电图12导联的不同ST-T改变及其临床表现和病变血管特点.方法回顾性分析63例急性回旋支闭塞的患者,根据急诊12导联心电图的表现随机分为ST段抬高组(43例)、单纯的胸导联ST段压低组(12例)和无ST段改变组(8例).比较三组的临床特点、冠状动脉病变特点及罪犯血管情况.结果与无ST段改变组相比,ST段抬高组和ST段压低组Killip分级更高(20.9%比16.7%比0,P=0.012),肌钙蛋白峰值更高(5.56ng/ml比5.75ng/ml比2.55ng/ml,P=0.001),左心室射血分数更低(52.3%比53.4%比58.4%,P=0.007).心电图表现为ST段压低组的再灌注治疗时间更缓慢、更容易出现二尖瓣反流(比例为25.0%,ST段抬高组为9.3%,无ST段改变组为0,P=0.03).常规12导联中单纯的胸导联ST段压低组中加做右胸导联和后壁导联发现有9例出现V7~V9导联ST段抬高.ST段压低组罪犯血管为回旋支近段的占41.7%,ST段抬高组罪犯血管为回旋支远端的占41.9%,无ST段改变组罪犯血管为钝缘支的占62.5%(P均<0.01).无ST段改变组存在侧支循环更多.结论回旋支闭塞的不同心电图改变代表不同的临床表现和病变血管特点,表现为ST段压低的患者需要更及时的再灌注治疗,加做V7~V9导联能够更及时地识别.Objective To study the different patterns of ST-segment changes, the clinical symptoms and the angiographic characteristics in patients with left circumflex artery ( LCX) occlusion. Methods 63 patients with LCX occlusion were categorized according to the admission ECG : ST-segment elevation group( ST-E group, n = 4 3 ), isolated ST-segment depression in precordial leads group(ST-D group, w= 12) and negligible ST-segment changes group (No-ST group, n=S). Clinical variables and coronary angiography were compared among the three groups. Results Compared with No-ST group, patients with ST-E group or ST-D group presented more advanced Killip class(20.9% vs. 16.7% vs. O ^^ O .O ^), higher troponin peak(5.56 ng/m l vs. 5.75 ng/m l vs. 2.55 ng/m l, P=0.001) and lower LVEF patients(52.3% vs. 53.4% vs. 58.4%,P=0.007). ST-D group were tardily reperfused and with higher mitral regurgitation (25.0% vs. 9.3% vs. 0 , P=0.03). Conclusion patients with different ST segment patterns o f LCX occlusion show different clinical and angiographic characteristics. Patients with STdepression pattern require more prompt reperfusion therapy.

关 键 词：回旋支闭塞 心电图表现 临床特点 

分 类 号：R540.41[医药卫生—心血管疾病]