一例冠状动脉无阻塞病变的变异型心绞痛患者的诊治过程并文献复习  

Diagnosis and Treatment Process and Literature Review of a Patient with Variant Angina Pectoris without Coronary Artery Obstruction

作　　者：王俐达 戚真[1] 朱宁[1] 王纪文[1] WANG Lida;QI Zhen;ZHU Ning;WANG Jiwen(The Second Hospital of Dalian Medical University,Dalian 116000,China)

机构地区：[1]大连医科大学附属第二医院,辽宁省大连市116000

出　　处：《中国全科医学》2021年第5期625-629,共5页Chinese General Practice

摘　　要：变异型心绞痛并不少见,但是冠状动脉无阻塞病变的变异型心绞痛并不多见。继2018年欧洲心脏病协会公布治疗指南之后,2019年美国心脏学会又公布了无阻塞性冠状动脉疾病诊治建议。提示此类病变越来越受到重视。冠状动脉无阻塞病变的变异型心绞痛患者的治疗在加用地尔硫以及尼可地尔后大多数症状可控制,但是仍有部分患者治疗困难,原因是冠状动脉无阻塞病变的变异型心绞痛的病因、机制不清楚。本文分享1例曾被诊断为心脏神经官能症的严重变异型心绞痛合并过敏性鼻炎、无冠状动脉狭窄、无冠状动脉慢血流患者的诊断及治疗过程,并进行文献复习。提示临床医生应注意当冠状动脉造影无狭窄病变时不可轻易放弃疾病的探索,特别是表现为右冠状动脉病变特点时(粗大右冠状动脉易发生痉挛)。冠状动脉痉挛病变的病因要注意过敏体质及应用激素的问题。Variant angina is not uncommon,but variant angina without coronary artery occlusion is rare.Following the publication of the management guidelines by the European Society Cardiology in 2018,the American Heart Association announced the recommendations for the diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease in 2019,which reflect that these diseases have attracted more and more attention.Most of the symptoms of patients with variant angina without coronary artery occlusion can be controlled after adding diltiazem and nicorandil,but the treatment for some patients is still very difficult due to unclear cause and pathogenesis of the disease.We reported the diagnostic and therapeutic procedure of a case of severe variant angina with allergic rhinitis without coronary stenosis and slow coronary flow,who was ever diagnosed with cardiac neurosis.Moreover,a literature review was made.The points for attention derived from this study are:Do not make a diagnosis hastily when there is no stenosis in coronary angiography,especially the patient is found to be with right coronal lesion(which is prone to spasm),it is essential to continue to identify clues for a definite diagnosis.And when exploring the causes of coronary artery spasm,allergic constitution and hormone application should be considered.

关 键 词：心绞痛 变异型 冠状血管造影术 鼻炎 过敏反应 过敏性鼻炎 综述 

分 类 号：R541.4[医药卫生—心血管疾病]