【作者】 左嵩；

【导师】 郑杨；

【作者基本信息】 吉林大学 ， 临床医学， 2012， 硕士

【摘要】 当冠状动脉粥样硬化性心脏病发生时，动脉内的粥样硬化导致狭窄并使局部心肌血流量减少，这种缺血的过程可导致心肌细胞的收缩及舒张功能受损，并逐渐出现运动状态异常，进而呈现室壁节段性运动异常。这种病理生理过程在冠脉三支血管病变中应表现得更为明显，继而表现为心室壁节段运动的异常。但在部分患者中，其心室壁运动反而呈现出正常运动。结合冠心病的危险因素及其病理生理改变，考虑冠脉三支血管病变但心室壁运动正常的原因有：缺血预适应及侧枝循环的形成等。冠脉三支血管病变患者是一种较普通冠心病更为广泛、弥散，更为严重的病变，当超声心动图提示心室壁节段运动正常，便容易在就诊时导致诊断上的疏漏，并最终造成个人家庭及社会的严重损失，因此，此类病变应引起我们的高度重视。目的：探讨冠状动脉三支血管病变合并心室壁运动正常的病例的临床特点；及与心室壁运动异常病例相对照，探寻可能导致心室壁运动正常的因素。方法：自2011年01月01日至2011年12月31日期间就诊于我院并行冠状动脉造影术的病例中筛出冠状动脉三支血管病变病例141例，其中，心室壁运动正常的有47例（A组），心室壁运动异常的有94例（B组）作为对照，记录两组冠心病患者的临床因素，并结合Gensini评分系统，运用SPSS17.0软件分别对其临床因素进行总体及分层对比，分析冠脉三支病变的临床特点及两组病例的差异对比。结果：两组患者的各年龄段百分比仍然不存在统计学差异（P=0.749）。其中心室壁运动正常组（A组）与心室壁运动异常组（B组）患者中年龄位于30-49岁的患者比例分别为16.6%vs.14.9%。而在50-69岁年龄段，A组与B组的比例分别为63.8%vs.58.5%。。两组患者首次发生心绞痛时间的构成比例存在统计学差异（P<0.05）。A组患者中发病24小时以内的比例大于B组患者(25.5%vs10.5%)两组EF值分段构成的比较中，A组患者EF值多位于正常范围（76.6%vs.57.4%），而B组的患者中，EF值轻度下降的比例较正常组大（35.1%vs14.9%）。A组患者的侧枝循环形成率的在Gensini积分位于100-149分时更高（75%vs.16.7%，P<0.05）；而在积分100-149分时B组患者的吸烟率更高（25%vs.83.3%，P<0.05）。结论：室壁运动正常的三支血管病变患者，其超声心动图的EF值更易表现为正常。存在侧枝循环的或不吸烟的严重三支血管病变患者，其超声心动图更易表现为室壁节段运动正常。更多还原

【Abstract】 As the occurrence of coronary atherosclerotic heart disease, atherosclerosis within theartery leads to stenosis and regional myocardial blood flow reduction. The process ofischemia can result in impaired systolic and diastolic function of the myocardial cells, andthe gradual emergence of movement abnormal state, thus showing regional wall motionabnormality. This pathophysiological process in the coronary tri-vessel disease should bemore obvious, and then ventricular wall motion abnormalities perform. However, in somepatients, ventricular wall motion shows a normal movement. To associate with coronaryheart disease risk factors and pathophysiological changes, consider the reason to thecoronary tri-vascular disease with normal ventricular wall motion may: the limitations of thecolor Doppler Echocardiography, ischemic preconditioning and the formation of cardiaccollateral circulation. coronary tri-vessel disease proves a kind of more widely dispersed, andmore serious disease, but binding with normal performance of the ventricular wallmovement in echocardiography, it seems more likely to result in diagnostic omissions, andeventually lead to serious losses for individuals, their families and society, and thereforesuch a disease should be worthy of being paid our much more attentions.Objective: To investigate the clinical features of cases with coronary tri-vessel diseasecombined with normal ventricular wall motion; and contrast with the ventricular wall motionabnormality cases, to explore the factors may result in normal ventricular wall motion.Methods: Screen out141cases with coronary tri-vessel disease from January1,2011to31December2011, including47patients with normal ventricular wall motion (group A), andventricular wall motion abnormalities94cases (group B) as a control. Record two groups ofpatients with clinical characteristics, combined with the Gensini score system, to deal withthe clinical factors by the overall and stratified contrast with SPSS17.0software, analyzeclinical features of coronary three-vessel disease, and the reasons that causing the differencesof these two groups.Results: The percentage of all ages of the patients were no significant difference (P=0.749). the proportions in normal wall motion group (group A) and abnormal ventricularwall motion group (B) at30-49years of age were16.6%vs.14.9%, in the50-69years agegroup, the proportions were63.8%vs.58.5%, respectively. For the composition ratio of the first time angina pectoris, in group of less than24hours of onset, the proportion of patientsin group A was larger than that in group B patients (25.5%vs10.5%,P<0.05). A comparisonof two groups’ EF value composition ratio, patients’ EF values in group A were most locatedin the normal range (76.6%vs.57.4%), while the proportion of EF value that slightlydecreased in group B was higher than normal group (35.1%vs14.9%, P<0.05). Cardiaccollateral circulation rate in group A was higher than group B in the Gensini score of100-149points (75%vs.16.7%, P<0.05); and group B had a higher smoking rates in100-149points than group A(25%vs.83.3%, P <0.05).Conclusion: For the patients of severe triple-vessel disease with cardiac collateralcirculation or non-smoking, their cardiac ventricular wall motion is more inclined to performnormal. EF values in patients with normal cardiac ventricular wall motion are more likely toshow normal.更多还原