不同梗死相关动脉完全闭塞的非ST段抬高型心肌梗死患者临床特征分析  

Clinical Characteristics of Non-ST Elevated Myocardial Infarction Patients with Complete Occlusion of Different Infarct-related Arteries

作　　者：肖文颖[1] 汪宇 张佳雨 史骏[1] 刘新兵[1] 冯六六[1] XIAO Wenying;WANG Yu;ZHANG Jiayu;SHI Jun;LIU Xinbing;FENG Liuliu(Internal Medicine-Cardiovascular Department,Shidong Hospital,Yangpu District,Shanghai,Shanghai 200438,China)

机构地区：[1]上海市杨浦区市东医院心内科,200438

出　　处：《实用心脑肺血管病杂志》2022年第3期8-11,16,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：上海市科技计划项目(21YF1443300);上海市医学重点专科建设项目(YP19ZA09)。

摘　　要：背景梗死相关动脉(IRA)完全闭塞在非ST段抬高型心肌梗死(NSTEMI)患者中越来越常见,其临床表现缺乏典型性。目的 分析不同IRA完全闭塞的NSTEMI患者的临床特征。方法 选取2018年3月至2021年3月入住上海市杨浦区市东医院心脏重症监护室(CCU)并经24 h内冠状动脉造影(CAG)证实IRA完全闭塞的NSTEMI患者79例为研究对象。收集患者一般资料、前驱症状、心电图检查结果、CAG检查结果。根据患者IRA,将其分为右冠状动脉(RCA)组(33例)、左回旋支(LCX)组(26例)和左前降支(LAD)组(20例)。结果 三组前驱症状比较,差异无统计学意义(P>0.05)。三组新出现的病理性Q波、ST段偏移、T波倒置、完全性左束支传导阻滞(CLBBB)发生率比较,差异无统计学意义(P>0.05)。三组三支病变、RCA优势型发生率比较,差异无统计学意义(P>0.05);LCX组侧支循环良好率低于RCA组(P<0.05);LAD组病变位置为近段者所占比例高于LCX组,病变位置为远段者所占比例低于LCX组(P<0.05)。前驱症状为气促的患者多见于LAD近段完全闭塞,前驱症状为头晕的患者多见于RCA近段完全闭塞,前驱症状为晕厥的患者均见于LCX完全闭塞,前驱症状为消化道症状的患者多见于RCA远段完全闭塞。结论 不同IRA完全闭塞NSTEMI患者前驱症状均以典型胸痛为主,但前驱症状为气促的患者多见于LAD近段完全闭塞,前驱症状为头晕的患者多见RCA近段完全闭塞,前驱症状为晕厥的患者均见于LCX完全闭塞,前驱症状为消化道症状的患者多见于RCA远段完全闭塞;不同IRA完全闭塞NSTEMI患者心电图检查结果无特异性;LCX完全闭塞NSTEMI患者CAG检查结果较差,其病情可能较为凶险。Background Complete occlusion of infarct-related artery(IRA)is becoming more and more common in patients with non-ST elevated myocardial infarction(NSTEMI),and its clinical manifestations are lack of typicality.Objective To analyze the clinical characteristics of NSTEMI patients with complete occlusion of different IRA.Methods A total of 79 NSTEMI patients who were admitted to the Coronary Care Unit(CCU)of Shidong Hospital,Yangpu District,Shanghai from March 2018 to March 2021 and confirmed complete occlusion of IRA by coronary angiography(CAG)within 24 hours were selected as the research objects.The general data,prodromal symptoms,ECG results and CAG results of patients were collected.According to IRA,patients were divided into right coronary artery(RCA)group(33 cases),left circumflex artery(LCX)group(26 cases)and left anterior descending artery(LAD)group(20 cases).Results There was no significant difference in prodromal symptoms among the three groups(P>0.05).There was no significant difference in the incidence of new pathological Q wave,ST segment offset,T wave inversion and complete left bundle branch block(CLBBB)among the three groups(P>0.05).There was no significant difference in the incidence of three vessel lesions and dominant RCA among the three groups(P>0.05).The good rate of collateral circulation in LCX group was lower than that in RCA group(P<0.05).The proportion of lesions located in the proximal segment in LAD group was higher than that in LCX group,and the proportion of lesions located in the distal segment was lower than that in LCX group(P<0.05).Patients who had shortness of breath as prodromal symptoms were more common with complete occlusion of proximal LAD,patients who had dizziness as prodromal symptoms were more likely to have complete occlusion of the proximal RCA,patients who had syncope as prodromal symptoms were seen with complete occlusion of the LCX,patients who had gastrointestinal symptoms as prodromal symptoms were mostly seen with complete occlusion of the distal RCA.Conclusion T

关 键 词：非ST段抬高型心肌梗死 梗死相关动脉 冠状动脉闭塞 临床特征 前驱症状 

分 类 号：R542.22[医药卫生—心血管疾病]