老年无Q波心肌梗死患者临床和冠状动脉病变特点  

Clinical and coronary angiographic features of non-Q wave myocardial infarction in the elderly

作　　者：夏云峰 罗北捷 刘润梅 翟红霞 殷亚昕 黄党生 李平生 

机构地区：[1]解放军第三○四医院干部病房,北京市100037

出　　处：《中华老年医学杂志》2003年第6期348-349,共2页Chinese Journal of Geriatrics

摘　　要：目的　评价老年Q波与无Q波型心肌梗死 (QMI与NQMI)患者的临床和冠状动脉病变的特点。　方法　记录QMI与NQMI患者的高血压、糖尿病病史 ,心肌梗死后的并发症和病死率 ,检测血脂、心肌酶 (CK MB) ,超声心动图测定左室射血分数 (LVEF) ,梗死后 3～ 4周内行冠状动脉造影 ,记录冠状动脉狭窄情况。　结果　两组患者中有高血压、糖尿病及高脂血症的比例相似 ,NQMI组CK MB峰值 (6 8 7± 18 6 )mmol/L明显低于QMI组 (10 8 6± 17 3)mmol/L(P <0 0 1) ,CK MB峰值时间 (17 8± 3 4 )h较QMI组 (2 1 9± 4 8)h提前 ,LVEF(5 6 1± 11 2 ) %高于QMI组(5 0 3± 16 7) % ,均为P <0 0 5 ,心律失常发生率和病死率均低于QMI组 (P <0 0 1) ;QMI组发生心源性休克 3例、心脏破裂 3例、室壁瘤形成 11例 ,而在NQMI组中未出现。单支、双支及 3支血管病变比例两组差异无显著性 (P >0 0 5 ) ;QMI组梗死相关动脉闭塞例数明显高于NQMI组 (P <0 0 1)。　结论　老年NQMI患者急性期预后较QMI患者好 ,梗死相关动脉闭塞率较QMI患者低。Objective To evaluate the clinical and coronary angiographic features of non-Q wave and Q wave myocardial infarction in the elderly. Methods The clinical history(including hypertension and diabetes), complication and in-hospital mortality, blood lipid, serum CK-Mb, LVEF, and the record of the coronary stenosis by angiography 3-4 weeks after infarction were investigated in non-Q wave and Q wave myocardial infarction patients. Results The clinical history and blood lipid did not differ significantly between the NQMI and QMI patients. NQMI patients had a significantly lower maximal peak 〔(68.7±18.6) mmol/L vs (108.6±17.3)mmol/L, P<0.01〕 and shorter time〔(17.8±3.4) h vs (21.9±4.8) h, P<0.05〕 of maximal peak in serum CK-Mb than QMI patients. LVEF were significantly enhanced in the NQMI patients. Cardiogenic shock in 3 patients, cardiac rupture in 3 patients and ventricular aneurysm in 11 patients were observed in QMI group while none happened in NQMI (P<0.01). The frequency of multivessel disease did not differ significantly between the two groups(P>0.05), but occlusion rate of infarct-related vessels in NQMI patients were lower. Conclusions Prognosis of NQMI patients is better than that of QMI patients in acute-phase, and the occlusion rate of infarct-related vessels in NQMI patients were lower.

关 键 词：老年 无Q波型心肌梗死 动脉闭塞率 冠状动脉造影术 

分 类 号：R542.22[医药卫生—心血管疾病]