无心肌梗死患者运动诱发心电图ST段抬高与冠状动脉狭窄的关系  

Relationship between exercise-induced ST-segment elevation and coronary artery stenosis in patients without myocardial infarction

作　　者：李玉凤[1] 袁超[1] 李岩[1] 王熙[1] 郭雅莲[1] 孙北 张纯燕[1] 周洋[1] 郭成军[2] 吴永全 方冬平[2] Li Yufeng;Yuan Chao;Li Yan;Wang Xi;Guo Yalian;Sun Bei;Zhang Chunyan;Zhou Yang;Guo Chengjun;Wu Yongquan;Fang Dongping(Electrocardiographic Room,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;the Twenty-first Ward,Pacing Center,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心电图室,北京100029 [2]首都医科大学附属北京安贞医院起搏中心二十一病房,北京100029

出　　处：《中国医药》2022年第9期1322-1325,共4页China Medicine

基　　金：首都卫生发展科研专项(首发2020-2-2062)。

摘　　要：目的分析无心肌梗死患者平板运动试验(TET)诱发心电图ST段抬高与冠状动脉狭窄的关系。方法回顾性选取2008年8月至2018年8月在首都医科大学附属北京安贞医院行诊断性TET检查出现ST段抬高并进一步行冠状动脉造影(CAG)检查的无心肌梗死患者22例。分析TET心电图ST段抬高与CAG检查冠状动脉狭窄的关系。结果22例患者中,1例(4.5%)冠状动脉正常;12例(54.5%)为单支病变,其中9例左前降支狭窄,3例右冠状动脉狭窄;5例(22.7%)为双支病变,其中1例是左前降支+右冠状动脉狭窄,2例左前降支+左回旋支狭窄,2例是左回旋支+右冠状动脉狭窄;4例(18.2%)为多支病变,均为左前降支+左回旋支+右冠状动脉狭窄。22例患者中11例胸导联ST段抬高,CAG显示均有左前降支病变,狭窄程度为50%~90%;8例Ⅱ和/或Ⅲ和/或aVF导联ST段抬高,CAG显示其中6例有右冠状动脉病变,狭窄程度为70%~100%,1例左前降支中段肌桥,对角支70%狭窄,1例只有左回旋支远段20%~30%狭窄;1例V1及aVR导联ST段抬高提示多支病变,CAG显示左前降支中段狭窄80%,对角支狭窄70%,左回旋支近段狭窄60%,钝缘支近段狭窄80%,右冠状动脉远段狭窄99%;1例V1及Ⅲ导联ST段抬高,CAG显示第一对角支近段狭窄40%,左回旋支近段狭窄50%,右冠状动脉开口狭窄90%;1例aVL导联ST段抬高,CAG显示左前降支中段狭窄90%,左回旋支中段狭窄85%。结论无心肌梗死患者TET诱发心电图ST段抬高多数与冠状动脉狭窄密切相关,需要高度重视。Objective To analyze the relationship between ST-segment elevation induced by treadmill exercise test(TET)and coronary artery stenosis in patients without myocardial infarction.Methods Totally 22 patients with ST-segment elevation who underwent diagnostic TET and then underwent coronary angiography(CAG)in Beijing Anzhen Hospital,Capital Medical University from August 2008 to August 2018 were retrospectively selected.The relationship between ST-segment elevation induced by TET and coronary artery stenosis in CAG was analyzed.Results Among the 22 patients,1 case(4.5%)had normal coronary artery;12 cases(54.5%)had single vessel disease,including 9 cases of left anterior descending artery stenosis and 3 cases of right coronary artery stenosis;5 cases(22.7%)were double vessel disease,including 1 case of left anterior descending branch+right coronary artery stenosis,2 cases of left anterior descending branch+left circumflex branch stenosis,and 2 cases of left circumflex branch+right coronary artery stenosis;4 cases(18.2%)were multivessel lesions,with left circumflex branch+left circumflex branch+right coronary artery stenosis.Among the 22 patients,11 cases had ST-segment elevation in the thoracic lead,and CAG showed left anterior descending branch lesions,with a stenosis degree of 50%-90%;in 8 cases with ST-segment elevation in leadsⅡand/orⅢand/or aVF,CAG showed that 6 of them had right coronary artery disease,with a stenosis degree of 70%-100%,1 case had a muscle bridge in the middle of the left anterior descending branch,70%stenosis in the diagonal branch,and 1 case had only 20%-30%stenosis in the distal segment of the left circumflex branch;one case with ST-segment elevation in leads V1 and aVR was suggested multi vessel disease,and CAG showed 80%stenosis in the middle of the left anterior descending branch,70%stenosis in the diagonal branch,60%stenosis in the proximal left circumflex branch,80%stenosis in the proximal blunt branch,and 99%stenosis in the distal right coronary artery;one case with ST-segment eleva

关 键 词：平板运动试验 心电图 ST段抬高 冠状动脉狭窄 

分 类 号：R541[医药卫生—心血管疾病]