摘要：
目的 探讨急诊冠状动脉造影(CAG)正常的急性心肌梗死(AMI)患者的临床特点及病因.方法 回顾性分析淮南市第一人民医院2015年10月至2017年10月行急诊CAG的AMI患者207例的临床资料,其中7例冠状动脉造影影正常.分析该7例患者的临床特点及病因.结果 CAG正常的AMI占3.38％(7/207),年龄(49.00±11.94)岁,男性4例,有吸烟史3例,高血压3例.实验室检查:肌钙蛋白Ⅰ(7.81±4.32)μg/L,肌红蛋白(231.43±136.03)μg/L,肌酸激酶同工酶B(15.3±4.63)μg/L.病因为冠状动脉痉挛1例(14.29％),心肌桥1例(14.29％),冠状动脉血栓自溶2例(28.57％),主动脉夹层2例(28.57％),心肌炎1例(14.29％).除主动脉夹层中1例死亡,1例转院以外,其余患者经住院治疗好转出院.结论 AMI主要是由于不稳定的动脉粥样斑块破裂诱发血栓形成阻塞血管所致,但部分CAG正常的患者也可以发生AMI,其发病具有不同临床特点及病因,实践中需仔细鉴别,以提高治愈率,改善患者预后.%Objective To investigate the clinical symptoms and pathogeny of acute myocardial infarction (AMI) in emergency normal coronary angiography ( CAG). Methods From October 2015 to October 2017,the clinical data of 207 AMI patients withemergency CAG in the First People's Hospital of Huainan were retrospectively analyzed,including 7 patients with normal CAG. The clinical symptoms and pathogeny of these patients were analyzed. Results Among the patients with AMI,the patients with normal CAG accounted for 3. 38 ％ (7 / 207),the average age was (49. 00 ± 11. 94)years old,4 patients were men,3 patients were smokers and 3 patients had hypertension. The results of laboratory examination were cTnI (7. 81 ± 4. 32)μg/ L,myoglobin (231. 43 ± 136. 03)μg/ L,CK - MB (15. 3 ± 4. 63)μg/ L. The pathogeny of these patients were one case with coronarospasm(14. 29 ％ ),one case with myocardial bridge(14. 29％ ),two cases with intracoronary thrombolysis(28. 57％ ),two cases with aortic dissection (28. 57％ ),and one case with myocarditis(14. 29％ ). In addition to aortic dissection in 1 case of death,1 case was transferred outside,the rest of the patients discharged after hospitalization. Conclusion AMI mainly occurres because of vascular thrombosis caused by the unstable coronary atherosclerosis plaque rupture,but some patients with normal CAG can also occure AMI,it has different clinical characteristics and pathogenys. In practice it should be carefully identified in order to improve the cure rate and prognosis.
