冠状动脉造影结果正常的临床诊断为急性冠脉综合征患者的病因分析

摘要

目的 分析冠状动脉造影结果正常的临床诊断为急性冠脉综合征(ACS)患者的病因.方法 选取2016年10月—2017年3月第四军医大学西京医院心脏内科重症监护室收治的临床诊断为ACS的患者546例,回顾性分析冠状动脉造影结果正常的临床诊断为ACS患者的病因.结果 546例临床诊断为ACS的患者中冠状动脉造影检查结果有临床意义者454例(占83.2%),正常者92例(占16.8%).92例冠状动脉造影检查结果正常者中ST段抬高34例(占37.0%),非ST段抬高58例(占63.0%);54例(占58.7%)为冠状动脉痉挛所致心绞痛,20例(占21.7%)为急性病毒性心肌炎,6例为心脏神经症(占6.5%),4例为心肌桥(占4.3%),3例为心肌炎(占3.3%), 2例为主动脉夹层(占2.2%),2例为嗜铬细胞瘤(占2.2%),1例为肺栓塞(占1.1%).结论 临床诊断为ACS但冠状动脉造影结果正常者以冠状动脉痉挛所致心绞痛、急性病毒性心肌炎等为主,临床应结合心肌酶谱变化、溶栓后血管再通情况及心电图变化等进一步有计划地完善相关检查,以明确诊断和指导临床合理治疗.%Objective To analyze the etiological factors in patients clinically diagnosed as acute coronary syndrome presenting normal coronary angiography examination results.Methods From October 2016 to March 2017,a total of 546 patients clinically diagnosed as acute coronary syndrome were selected in the Cardiac Intensive Care Unit,Xijing Hospital of the Fourth Military Medical University,the etiological factors in patients presenting normal coronary angiography examination results were retrospectively analyzed.Results Of the 546 patients clinically diagnosed as acute coronary syndrome,454 cases found positive coronary angiography examination results with clinical significance(accounting for 83.2%);92 cases found normal coronary angiography examination results(accounting for 16.8%),including 34 cases with ST-segment elevation(accounting for 37.0%) and 58 cases with non ST-segment elevation(accounting for 63.0%),54 cases with coronary artery spasm-induced angina pectoris(accounting for 58.7%),20 cases with acute viral myocarditis(accounting for 21.7%),6 cases with cardiac neurosis(accounting for 6.5%),4 cases with myocardial bridge(accounting for 4.3%),3 cases with myocarditis (accounting for 3.3%),2 cases with aortic dissection(accounting for 2.2%),2 cases with pheochromocytoma(accounting for 2.2%),1 case with pulmonary embolism(accounting for 1.1%).Conclusion Patients clinically diagnosed as acute coronary syndrome presenting normal coronary angiography examination results mainly are coronary artery spasm-induced angina pectoris,acute viral myocarditis and so on,clinicians should systematically carry out relevant examinations according to the changes of myocardial enzyme,vascular recanalization after thrombolytic therapy,to confirm the diagnosis and guide clinical rational treatment.