摘要
目的分析冠状动脉痉挛(coronary artery spasm,CAS)合并粥样硬化性狭窄患者的临床特点,并依患者的病情特点选择个体化诊治策略。方法采取回顾性研究方法,选取玉林市第一人民医院2015年6月至2016年5月期间收治且被确定为存在CAS同时合并粥样硬化性狭窄(固定狭窄)的患者36例作为研究对象。主要分析其危险因素、临床症状、心电图表现、冠状动脉造影(CAG)结果等情况,以及经药物治疗或联合支架植入术后的疗效。结果 36例患者中有30例(83.3%)存在长期大量吸烟习惯,15例(41.7%)血液中高敏C-反应蛋白(high sensitivity C-reactive protein,hs-CRP)浓度偏高于正常范围值,3例(8.3%)存在血压偏低或处于临界值状态。36例患者中15例(41.6%)胸痛表现明显,且其症状出现时心电图有典型的ST段抬高或明显压低的缺血表现;18例(50%)胸闷胀;3例(8.3%)无明显症状。冠状动脉造影提示CAS明显且同时合并严重狭窄(固定狭窄≥75%)8例,此8例患者均为男性,其中2例年龄<40岁、5例年龄>60岁;8例中有7例(包括2例年龄<40岁)长期大量吸烟;此8例患者均于首次冠状动脉造影后予植入冠状动脉支架,术后常规药物治疗,随访半年随访显示治疗均有效。CAS合并轻-中度狭窄(20%≤固定狭窄<75%)28例,综合考虑均无需植入冠状动脉支架但均尝试药物治疗,观察半年显示治疗有效26例,而其中2例(1男,1女)合并中度狭窄治疗无效,且半年后复查冠状动脉造影提示原固定狭窄程度较前加重,遂予植入冠状动脉支架,术后继续药物治疗,随访半年显示治疗有效。结论对于CAS合并狭窄患者,吸烟为其重要的危险因素,hs-CRP亦为重要的预测因子,而病变严重需植入支架者则与其同时存在年老、糖尿病等其他高危因素有较大关系。药物仍是治疗的有效手段,对于血管痉挛且合并较明显粥样硬化性狭窄的患者,选择药物联合支架植入可获得较良好的�
Objectives To study and analyze the clinical characteristics of patients with coronary artery spasm（CAS） complicated with atherosclerotic stenosis ,and to make diagnosis and treatment strategies according to their disease char-acteristics. Methods Totally 36 hospitalized patients with CAS complicated with atherosclerotic stenosis（fixed steno-sis）in period of June 2015 to May 2016 were retrospectively studied. The risk factors,clinical symptoms,electrocar-diogram manifestations and the results of coronary angiography （CAG） were carefully studied and analyzed. Mean-while,the curative effects by medicine-only or by medicine combined with coronary stenting were observed in these cases. Results Among the 36 cases,30 cases（83.3%）had a long history of smoking,15（41.7%）cases had a high-er concentration of high sensitivity C-reactive protein （hs-CRP） than the normal range value ,and 3 （8.3%） cases were in a relative low or at a critical value state of blood pressure. Of the 36 cases,15 cases（41.6%）showed obvious chest pain and presented a typical and notable ST segment elevation or depression in electrocardiogram when the symp-toms appeared,18 cases（50%）showed chest tightness or chest distension,and 3（8.3%）cases had no chest symp-toms. There were 8 male cases with obvious CAS and severe stenosis （fixed stenosis≥75%） indicated by CAG ,of which 2 cases were younger than 40 years and 5 cases were older than 60 years,and 7 cases（including the 2 cases that younger than 40 years）among them had a long history of smoking. The 8 cases received intracoronary stent implan-tation after primary CAG ,and medications were also given after coronary stenting. An half year follow-up showed that the curative effect of the 8 cases were satisfactory and encouraging. There were 28 cases with CAS and light-moderate stenosis（20%≤fixed stenosis〈75%）had no need of intracoronary stent implantation,but all of them were treated by medication only. After half a year ,26 cases of them received g
出处
《岭南心血管病杂志》
2017年第5期537-541,共5页
South China Journal of Cardiovascular Diseases
关键词
冠状动脉痉挛
冠状动脉粥样硬化性狭窄
药物治疗
支架植入
疗效
coronary artery spasm
coronary artery atherosclerotic stenosis
medication
stent implantation
cura-tive effects
