变异型心绞痛心律失常特点临床分析  

The Clinical Assess of Characteristics of Arrhythmia accompanied with Variant Angina Attack

作　　者：孟晓峰[1] 王芮 祁哲[3] 

机构地区：[1]中国航空工业中心医院,100012 [2]朝阳区第二医院 [3]中国医学科学院阜外心血管病医院

出　　处：《航空航天医药》2003年第4期193-194,共2页Aerospace Medicine

摘　　要：目的 :探讨变异型心绞痛 (VA)患者 ,心绞痛发作时伴发各种类型心律失常的临床特点及其发生机制。方法 :临床观察 88例VA患者 ,均采用 18导联心电图或CM5和CMavF导联系统进行 2 4小时监测(Holter) ,记录VA患者心肌缺血时间的长短、伴发心律失常的有无、类型及发作时相 ,并均行冠状动脉造影检查 ,明确冠状动脉病变有无以及病变部位。结果 :88例VA患者心肌缺血发作时有 48例患者发生心律失常 ,其心律失常的发生率为 5 4.5 %。快速性和缓慢性心律失常均有发生 ;在前壁心肌缺血发作时 ,室性心律失常多见。其中室性心动过速的患者 ( 9例 ) ,室性期前收缩 2 1例 ,心室颤动 2例。下壁心肌缺血发作时常见缓慢型心律失常 ;如窦性心动过缓、窦性停搏及房室传导阻滞。 48例发生心律失常的患者中 ,缺血持续时间平均为 9.2 4分钟 ,而在 40例未发生心律失常的患者中 ,缺血持续时间平均为 4分钟 ;42例患者 ( 87.5 % )的心律失常发生在缺血闭塞期 ,6例患者 ( 12 .5 % )的心律失常发生在缺血再灌注期。结论 :①VA可并发闭塞期和再灌注期心律失常 ,但以前者为多 ;②右冠状动脉痉挛引起下壁心肌缺血时 ,易造成缓慢性心律失常 ;而左前降支冠状动脉痉挛引起前壁心肌缺血时 ,则易发生快速性心律失常和或严重室性心律失常 ;③VA?Objective: To assess the characteristics and machanism of arrhythmia accompanied with variant angina(VA) attack.Methods: It was a retrospective study of 88 patients with Va, who had undergone 18-lead electrocardiogram / Holter and coronary arteriongraphy (CAG).Results: The incidence of arrhythmia (including tachycardia and bradycardia) in the 88 patients was 54.5%. When myocardial ischemia occurred on anterior wall, ventricular arrhythmia often appear, including 9 ventricular tachycardia often accompanied with myocardial ischemia on inferior wall. Myocardial ischemia in the 48 patients with arrhythmia and the 40 patients without arrhythmia averagely lasted for 9.24 minutes and 4 minutes respectively 87.5% of the arrhythmia occurred in the spasm period, 12.5% occurred in the reperfusion period.Conclusion: (1)Arrhythemia can occur in both spasm period and reperfusion period, but more often in the spasm period. (2) Spasm on RCA induced myocardial ischemia on inferior wall often accompany with bradycardia. Spasm on LAD induced myocardial ischemia on anterior wall was most likely accompanied with tarchycardia or severe ventricular arrhythmia. (3) The duration of spasm was corellated to the incidence and prognosis of arrhythmia.

关 键 词：变异型心绞痛 冠状动脉痉挛 心律失常 

分 类 号：R541.7[医药卫生—心血管疾病]