冠状动脉病变特征与临床表现及预后的关系研究

【作者】 李爱凤；

【导师】 崔连群；

【作者基本信息】 山东大学 ， 内科学， 2007， 硕士

【摘要】 目的：对MI患者MI前、后心绞痛、超声心电图及冠状动脉造影特征等指标(与对照组测值)做了系统的研究和比较，探讨MI患者的冠状动脉病变特征与临床表现及左心室功能的关系、并对50例行冠状动脉介入治疗的患者做活动平板运动试验、左心室功能检查，探索影响PCI患者预后的因素。方法：对70例急性MI患者及40例对照作冠状动脉造影、超声心动图检查。对患者的MI前、后心绞痛、超声心动图及冠状动脉造影的有关指标与对照组测值做了系统的研究和比较，分析MI前、后心绞痛及无心绞痛患者冠状动脉病变特征。对50例行冠状动脉介入治疗患者术前行活动平板运动试验及超声心动图检查，并对其出院后进行随访，随访终点为心血管事件发生。心血管事件包括心源性死亡，心肌梗塞，因心衰、心绞痛加重而住院，再次PTCA或CABG。对入选患者进行电话随访或行门诊随访。结果：MI前、后心绞痛提示多支冠脉病变和较丰富的侧支循环。单支冠脉病变发生MI时，其彩超MI区室壁运动降低，非MI区运动则正常或增强；但多支冠脉病变者发生MI时，除引起MI区运动障碍外，还引起非MI区室壁运动降低，后者对预测多支冠脉病变有一定价值。对50例冠状动脉介入治疗患者(PCI)行活动平板运动试验表明，冠状动脉狭窄程度较重，运动试验中ST段压低出现时间越早、幅度越大、持续时间越长；冠状动脉病变部位与ST段阳性改变的导联之间有一定的对应关系，分布频率较高的导联是Ⅱ、Ⅲ、AVF、V2-V6导联，但并不总是恒定和唯一的。并对其出院后进行随访。平均随访时间为10±3.5个月，失访7例，占14％。43例患者发生心血管事件共12例，1例死亡，死亡原因为心衰合并室性心律失常，2例再次行PTCA，1例行CABG，1例患者出现心肌梗塞，7例患者发生心绞痛。按有无心血管事件发生分成两组进行基线水平比较，在年龄、性别、吸烟、高血压、糖尿病及血脂方面无显著差异。多因素分析显示，冠状动脉多支病变、长病变，较早出现活动平板运动试验阳性、室壁运动异常及EF降低(＜0.40)，是PCI后发生心血管事件的独立风险因子。结论：1．MI前、后心绞痛提示多支冠状动脉病变；2．活动平板运动试验对冠状动脉多支病变具有诊断价值，可行初步判断冠状动脉病变部位和程度；3．室壁运动异常对预测冠脉病变有一定意义；4．冠状动脉多支病变、长病变、活动平板运动试验阳性、超声心动室壁运动异常及EF＜0.40是心脏事件的独立危险因素。更多还原

【Abstract】 Objective: to MI in front of patient MI, the back of the body colic, the supersonic electrocardiogram and target and so on coronary artery radiography characteristic (with comparison group measured value) has done the system research and compares, discusses the MI patient’s coronary artery pathological change characteristic and the clinical manifestation and the left ventricle function relations, and performs the active dull movement experiment, the left ventricle functional check to 50 routine coronary arteries involvement treatment patient, the exploration affects PCI patient pre- after the factor.Method: Makes the coronary artery radiography, the ultrasonic cardiogram inspection to 70 examples acute MI patient and 40 examples comparison. To patient’s MI in front of, the back of the body colic, the ultrasonic cardiogram and the coronary artery radiography related target and the comparison group measured the value has done the system research and compares, Analyzes in front of MI, the back of the body colic and unintentionally the colic patient coronary artery pathological change characteristic, treats the patient technique vanguard activity dull movement experiment and the ultrasonic cardiogram inspection to 50routine coronary arteries involvement, and leaves the hospital after it carries on makes a follow-up visit, makes a follow-up visit the end point to occur for the cardiovascular event. Cardiovascular event including heart source death, myocardial infarction, because the heart fades, the angina pectoris aggravates is hospitalized, once more PTCA or CABG Carries on the telephone to the selected patient to make a follow-up visit or the good out patient service makes a follow-up visit.Results: In front of MI, the back of the body colic prompts many crowns arteries pathological change and the richer lateral support circulation. When the single arteries pathological change has MI, its color ultra MI area room wall movement reduces, the non- MI area movement then is normal or the enhancement; When many crowns arteries pathological change has MI, besides causes the MI area movement barrier, but also causes the non- MI area room wall movement to reduce, latter to forecast many crowns arteries pathological change has the certain value. Treats the patient to 50 examples coronary artery involvement (PCI)the line of active dull movement experiment to indicate that, coronary artery narrow degree heavier, in the movement experiment the ST section reduces the epoch more early, goes past in a big way, the duration to be longer; The coronary artery pathological change spot and the ST section masculine gender change leads between the association to have the certain corresponding relations, the distributed frequency higher leads the association is II, III, AVF, V2-V6 leads the association, but certainly not always constant and only. The average makes a follow-up visit the time for 10±3.5 a month, loses visits 7 examples, accounts for 14%.43 examples patients have the cardiovascular event altogether 12examples, 1 example death, the cause of death fades the merge room for the heart Arrhythmia , 2 examples line of PTCA, 1 routine CABG, 1example patient appears myocardial infarction once more, 7 examples patients have the angina pectoris. Occurs whether there is according to the cardiovascular event divides into two groups to carry on the baseline level comparison, in age,sex, smoking, hypertension, diabetes and blood fats aspect not remarkable difference. The multi- factor analysis demonstration, coronary artery many pathological changes, the long pathological change, comparatively early appear the active dull movement experiment masculine gender, the room wall movement exceptionally and EF reduces ( < 0.40 ) , after is PCI has the cardiovascular event independent risk factor.Conclusion: 1.In front of 1.MI, the back of the body colic prompts many coronary artery pathological change; 2. active dull movement sex periment has the diagnosis value to coronary artery many pathological changes, feasible preliminary judgement coronary artery pathological change spot and degree; 3. The room wall movement exceptionally to forecast the crown arteries pathological change has the certain significance; 4. coronary arteries many pathological changes, long pathological change, the active dull movement experiment masculine gender, the supersonic heart movement room wall movement exceptionally and EF < 0.40 is the heart event independence dangerous factor.更多还原