中国医药
中國醫藥
중국의약
CHINA MEDICINE
2012年
6期
662-664
,共3页
王春梅%朱小玲%张丽%艾辉%李响%刘子军
王春梅%硃小玲%張麗%艾輝%李響%劉子軍
왕춘매%주소령%장려%애휘%리향%류자군
回旋支%下壁心肌梗死,急性%临床特点%预后
迴鏇支%下壁心肌梗死,急性%臨床特點%預後
회선지%하벽심기경사,급성%림상특점%예후
Left circumflex artery%Inferior wall myocardialinfarction,acute%Clinical characteristics%Prognosis
目的 分析回旋支与右冠状动脉闭塞导致急性下壁心肌梗死的不同特点,观察30 d预后情况.方法 选择2008年1月至2011年12月于我院抢救中心住院行直接经皮冠状动脉介入治疗(PCI)的急性下壁心肌梗死患者共621例,根据冠状动脉造影显示的梗死相关动脉情况分为2组,右冠状动脉组515例,回旋支组106例.比较2组临床特征及PCI术中特点,分析2组患者预后.结果 右冠状动脉组与回旋支组年龄、男性比例、高血压病史、糖尿病病史、吸烟史、舒张压、发病至就诊时间等一般资料比较差异无统计学意义(均P＞0.05)；而右冠状动脉组合并右心室心肌梗死比例、ST段抬高总和、左心室射血分数明显高于回旋支组[29.3％ (151/515)比4.7％ (5/106),(11.0±2.8) mm比(9.8±3.3) mm,(57±12)％比(55±10)％],入院时收缩压、肌钙蛋白Ⅰ峰值及心肌型肌酸激酶同工酶峰值、30 d病死率则明显低于回旋支组[(119±29)mm Hg(1 mm Hg=0.133 kPa)比(126±31)mm Hg,(47±30) μg/L比(55±33)μg/L,(160±71)U/L(176±73)U/L,3.9％(20/515)比8.5％(9/106)],2组之间差异有统计学意义(均P＜0.05).2组术前心肌梗死溶栓试验(TIMI)0级血流率、多支血管病变比例、手术操作时间、就诊距血管再通时间、术后TIMI 3级血流率、术中应用主动脉内气囊泵支持等方面差异无统计学意义[ 64.5％ (332/515)比57.5％(61/106),51,7％(266/515)比49.1％ (52/106),(50±22) min比(55±27) min,(77±13) min比(79±12)m in,93.4％(481/515)比92.5％(98/106),8.2％ (42/515)比7.5％ (8/106),均P＞0.05].多因素分析结果显示回旋支闭塞是30 d病死率的独立影响因素(OR=1.167,95％ CI:0.992～1.963,P=0.033).结论 回旋支闭塞导致的急性下壁心肌梗死心电图表现不典型,30 d病死率较高,预后较差.
目的 分析迴鏇支與右冠狀動脈閉塞導緻急性下壁心肌梗死的不同特點,觀察30 d預後情況.方法 選擇2008年1月至2011年12月于我院搶救中心住院行直接經皮冠狀動脈介入治療(PCI)的急性下壁心肌梗死患者共621例,根據冠狀動脈造影顯示的梗死相關動脈情況分為2組,右冠狀動脈組515例,迴鏇支組106例.比較2組臨床特徵及PCI術中特點,分析2組患者預後.結果 右冠狀動脈組與迴鏇支組年齡、男性比例、高血壓病史、糖尿病病史、吸煙史、舒張壓、髮病至就診時間等一般資料比較差異無統計學意義(均P＞0.05)；而右冠狀動脈組閤併右心室心肌梗死比例、ST段抬高總和、左心室射血分數明顯高于迴鏇支組[29.3％ (151/515)比4.7％ (5/106),(11.0±2.8) mm比(9.8±3.3) mm,(57±12)％比(55±10)％],入院時收縮壓、肌鈣蛋白Ⅰ峰值及心肌型肌痠激酶同工酶峰值、30 d病死率則明顯低于迴鏇支組[(119±29)mm Hg(1 mm Hg=0.133 kPa)比(126±31)mm Hg,(47±30) μg/L比(55±33)μg/L,(160±71)U/L(176±73)U/L,3.9％(20/515)比8.5％(9/106)],2組之間差異有統計學意義(均P＜0.05).2組術前心肌梗死溶栓試驗(TIMI)0級血流率、多支血管病變比例、手術操作時間、就診距血管再通時間、術後TIMI 3級血流率、術中應用主動脈內氣囊泵支持等方麵差異無統計學意義[ 64.5％ (332/515)比57.5％(61/106),51,7％(266/515)比49.1％ (52/106),(50±22) min比(55±27) min,(77±13) min比(79±12)m in,93.4％(481/515)比92.5％(98/106),8.2％ (42/515)比7.5％ (8/106),均P＞0.05].多因素分析結果顯示迴鏇支閉塞是30 d病死率的獨立影響因素(OR=1.167,95％ CI:0.992～1.963,P=0.033).結論 迴鏇支閉塞導緻的急性下壁心肌梗死心電圖錶現不典型,30 d病死率較高,預後較差.
목적 분석회선지여우관상동맥폐새도치급성하벽심기경사적불동특점,관찰30 d예후정황.방법 선택2008년1월지2011년12월우아원창구중심주원행직접경피관상동맥개입치료(PCI)적급성하벽심기경사환자공621례,근거관상동맥조영현시적경사상관동맥정황분위2조,우관상동맥조515례,회선지조106례.비교2조림상특정급PCI술중특점,분석2조환자예후.결과 우관상동맥조여회선지조년령、남성비례、고혈압병사、당뇨병병사、흡연사、서장압、발병지취진시간등일반자료비교차이무통계학의의(균P＞0.05)；이우관상동맥조합병우심실심기경사비례、ST단태고총화、좌심실사혈분수명현고우회선지조[29.3％ (151/515)비4.7％ (5/106),(11.0±2.8) mm비(9.8±3.3) mm,(57±12)％비(55±10)％],입원시수축압、기개단백Ⅰ봉치급심기형기산격매동공매봉치、30 d병사솔칙명현저우회선지조[(119±29)mm Hg(1 mm Hg=0.133 kPa)비(126±31)mm Hg,(47±30) μg/L비(55±33)μg/L,(160±71)U/L(176±73)U/L,3.9％(20/515)비8.5％(9/106)],2조지간차이유통계학의의(균P＜0.05).2조술전심기경사용전시험(TIMI)0급혈류솔、다지혈관병변비례、수술조작시간、취진거혈관재통시간、술후TIMI 3급혈류솔、술중응용주동맥내기낭빙지지등방면차이무통계학의의[ 64.5％ (332/515)비57.5％(61/106),51,7％(266/515)비49.1％ (52/106),(50±22) min비(55±27) min,(77±13) min비(79±12)m in,93.4％(481/515)비92.5％(98/106),8.2％ (42/515)비7.5％ (8/106),균P＞0.05].다인소분석결과현시회선지폐새시30 d병사솔적독립영향인소(OR=1.167,95％ CI:0.992～1.963,P=0.033).결론 회선지폐새도치적급성하벽심기경사심전도표현불전형,30 d병사솔교고,예후교차.
Objective To evaluated the clinical characteristic and 30-day clinical outcomes of acute inferior wall ST-elevation myocardial infarction from occlusion of the left circumflex artery (LCX) and the right coronary artery (RCA).Methods From January 2008 to December 2011,621 acute inferior wall ST-elevation myocardial infarction patients who underwent primary pereutaneous coronary intervention(PCI) were enrolled in a single center retrospective study.Of621 cases,515 patients were enrolled in RCA group and 106 patients in LCX group.Results There were no significant differences between two groups in terms of age,sex,hypertension,diabetes,smoking,diastolic pressure,ischemia time ( all P ＞ 0.05 ).The proportion of combined with right ventricular acute myocardial infarction,the sum of ST-elevation and left ventricular ejection fraction were remarkably higher in group RCA than those in LCX group[29.3％ (151/515) vs 4.7％ (5/106),(11.0 ±2.8)mm vs (9.8 ±3.3) mm,(57 ± 12)％ vs (55 ± 10)％ ],while systolic blood pressure,the peak level of creatine kinase-isoenzyme,troponin Ⅰ and 30-day mortality in group RCA were lower[ ( 119 ± 29)mm Hg vs (126 ± 31 )mm Hg,(47 ± 30)μg/L vs (55 ± 33 ) μg/L,( 160 ± 71 ) U/L vs ( 176 ±73)U/L,3.9％ (20/515) vs 8.5％ (9/106) ] (all P ＜0.05).There were not significant difference in thrombolysis in myocardial infarction(TIMI) 0 flow,multiple-vessel disease,procedural time,door to balloon time,final TIMI 3 flow and intra-aortic balloon pump support between the group RCA and LCX group [64.5％ (332/515) vs 57.5％ (61/106),51.7％ (266/515) vs 49.1％ (52/106),(50 ± 22) min vs (55 ±27)min,(77 ± 13)min vs (79 ± 12)min,93.4％ (481/515) vs 92.5％ (98/106),8.2％ (42/515) vs 7.5％ (8/106),all P ＞0.05].Multivariate analysis demonstrated that LCX was a risk factor of 30-day mortality( OR =1.167,95％ CI:0.992-1.963,P =0.033 ).Conclusions The electrocardiograph of occlusion of the left circumflex artery is atypia.The 30-day prognostic outcome is poorer in LCX-related acute inferior wall myocardial infarction.
