摘要
目的探讨变异型心绞痛(variant angina pectoris,VAP)患者痉挛靶血管部位的判断及其与心律失常的关系。方法回顾性分析160例VAP患者的临床资料,根据VAP发作时心电图ST-T抬高的导联部位,判断相对应的痉挛靶血管,统计VAP发作时不同痉挛靶血管心律失常检出率,心律失常发生机制及VAP性晕厥发生情况。结果 160例VAP患者中左冠状动脉痉挛型94例(58.75%)[其中左前降支88例(55.00%),左回旋支2例(1.25%),左主干4例(2.50%)],右冠状动脉痉挛型46例(28.75%),多支冠状动脉痉挛型20例(12.50%);VAP发作时检出心律失常86例(53.75%),左前降支痉挛心律失常检出率(42.05%)低于右冠状动脉痉挛(65.22%)(P<0.05),其中室性心律失常检出率(27.27%)高于右冠状动脉痉挛(10.87%),缓慢性心律失常检出率(5.68%)低于右冠状动脉痉挛(47.83%)(P<0.05);86例心律失常患者中,缺血性心律失常比率(76.74%)高于再灌注性心律失常(16.30%)和双期性心律失常(6.96%)(P<0.05);左前降支缺血性心律失常比率(67.57%)低于右冠状动脉(90.00%),再灌注性心律失常比率(27.02%)高于右冠状动脉(3.33%)(P<0.05);VAP发作时,23例(14.38%)发生VAP性晕厥,其中左前降支5例(21.74%)、左主干4例(17.39%)、右冠状动脉10例(43.48%)、多支冠状动脉4例(17.39%),左前降支VAP性晕厥比率低于右冠状动脉(P<0.05)。结论 VAP患者痉挛靶血管主要为左前降支,其次为右冠状动脉;VAP发作时心律失常主要由靶血管痉挛致心肌缺血引起;左前降支痉挛易引起室性心律失常,右冠状动脉痉挛易引起缓慢性心律失常;VAP发作时发生VAP性晕厥的主要原因是右冠状动脉痉挛所致的缓慢性心律失常。
Objective To explore the relationship between the spasmodic targeted coronary artery and arrhythmia in patients with variant angina pectoris(VAP).Methods The clinical data of 160 patients with VAP were retrospectively analyzed.The ST-T elevation at VAP attacking was recorded on different lead ECG to judge the corresponding spasmodic targeted coronary artery.The detection rate and mechanism of arrhythmia as well as VAP syncope were recorded and analyzed at VAP attacking.Results In 160 patients with VAP,there were 94 patients with left coronary artery spasm(58.75%)(left anterior descending(LAD)in 88 patients(55.0%),left circumflex artery(LCX)in 2 patients(1.25%),left main trunk in 4 patients(2.50%)),46 patients with right coronary artery(RCA)spasm(28.75%)and 20 patients with multiple coronary artery spasm(12.50%).Arrhythmia was detected in 86patients(53.75%)at VAP attacking.The detection rate of arrhythmia caused by LAD artery spasm(42.05%)was significantly lower than that of arrhythmia caused by RCA spasm(65.22%)(P<0.05),in which the detection rate of ventricular arrhythmia caused by LAD artery spasm(27.27%)was significantly higher than that of arrhythmia caused by RCA artery spasm(10.87%)(P<0.05),and the detection rate of slow arrhythmia caused by LAD artery spasm(5.68%)was significantly lower than that of arrhythmia caused by RCA spasm(47.83%)(P<0.05).In 86 patients with arrhythmia at VAP attacking,the ischemic rate(76.74%)was significantly higher than reperfusion arrhythmia rate(16.30%)and biphasic arrhythmia rate(6.96%)(P<0.05).The rate of ischemic arrhythmia caused by LAD artery spasm(67.57%)was significantly lower than that of arrhythmia caused by RCA spasm(90.00%),and the rate of reperfusion arrhythmia caused by LAD artery spasm(27.02%)was significantly higher than that of arrhythmia caused by RCA spasm(3.33%)(P<0.05).VAP syncope occurred in 23 patients(14.38%)at VAP attacking,caused by LAD spasm in 5 patients(21.74%),left main trunk spasm in 4(17.39%),RCA spasm in 10(43.38%)and LCX spasm in 4(17.39%),and the rate of VAP syncope caused by LAD spasm was significantly lower than that of syncope caused by RCA spasm(P<0.05).Conclusion Spasmodic targeted vessel is mainly LAD in VAP patients,followed by RCA.Spasticity of target vasospasm caused by myocardial ischemia is the main cause of arrhythmia.LAD spasm easily leads to ventricular arrhythmia,and RCA spasm easily leads to bradycardiac arrhythmia.The main cause of VAP syncope at VAP attacking is slow arrhythmia caused by RCA spasm.
出处
《中华实用诊断与治疗杂志》
2017年第9期854-858,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
河南省医学科学攻关项目(2006-0131)
关键词
变异型心绞痛
冠状动脉痉挛
心律失常
靶血管
晕厥
Variant angina pectoris
coronary artery spasm
arrhythmia
targeted vessel
syncope
