冠状动脉痉挛性心绞痛125例临床分析

摘要

Objective To investigate the features and treatment of patients with coronary spastic angina(CSA).Methods From October 2010 to August 2016, 125 patients with CSA were selected, the ECG and coronary angiography were analyzed.The correlation between coronary artery spasm and stenosis was studied, and given corresponding treatment.Results Coronary angiography examination was performed in 112 patients, including 108 patients with single coronary artery spasm, among which, 39 patients had significant coronary disease (≥50.0%), 29 patients had completely normal coronary arteriograms, when there was significant coronary stenosis, the incidences of single angiogenesis vasospasm, LAD(76.3%) were significantly higher than RCA (21.1%) and LCX(2.6%);when there was no significant stenosis, the incidence of RCA (68.6%) was significantly higher than LAD (25.7%) and LCX(4.3%).All the patients received calcium-channel blockers and/or nitrate.Percutaneous coronary interventions was performed in 17 patients with significant coronary stenosis.Conclusions CAS is not rare, can occur in patients with normal coronary artery or the pathological changes.Serious and continuous vasospasm can lead to acute myocardial infarction and malignant arrhythmia.Using drug to relieve vasospasm is still the first scheme.%目的 探讨冠状动脉痉挛性心绞痛(CSA)的临床特点及治疗方法.方法 选取2010年10月至2016年8月CAS患者125例,分析其心电图、冠状动脉造影等临床表现,分析冠状动脉痉挛与狭窄病变的关系,给予相应治疗.结果 112例患者行冠状动脉造影检查,其中单支冠状动脉痉挛108例,有显著狭窄病变39例,冠状动脉完全正常29例.在单支血管发生痉挛方面,冠状动脉存在显著狭窄(≥50.0%)时,前降支痉挛的发生率(76.3%)明显高于右冠状动脉(21.1%)和回旋支(2.6%);在冠状动脉无显著狭窄病变时,右冠状动脉痉挛的发生率(68.6%)明显高于前降支(25.7%)和回旋支(4.3%).所有患者均接受了钙拮抗剂和(或)硝酸酯类药物治疗.17例合并冠状动脉显著狭窄者行介入治疗.结论 冠状动脉痉挛性心绞痛可发生于冠状动脉正常或有病变的人群,严重持续的痉挛可导致急性心肌梗死及恶性心律失常,强化药物治疗仍为解除痉挛的首选方案.