摘要
目的分析总结冠状动脉左主干不同程度病变的临床及心电图特点,以期有助于早期风险评估及临床诊疗。方法回顾分析2008年1月至2014年12月于我院行冠状动脉造影检查确诊左主干病变的227例患者,根据左主干造影狭窄程度将患者分为A组(狭窄程度50%~70%,73例),B组(狭窄程度≥70%,154例)。分析2组患者的临床资料及心电图特点。结果 A组年龄45~79岁,平均(61.1±11.5)岁;B组年龄30~79岁,平均(56.5±10.4)岁,差异有统计学意义(P=0.000)。A组的心绞痛发生率为61.6%,显著低于B组的82.5%(P=0.001),2组既往心肌梗死、高血压、糖尿病、高脂血症等病史差异无统计学意义。左主干狭窄程度越高累及导联范围越广,Ⅰ、av L、V4~5导联累及程度最高,Ⅰ、av L、V1、V3~6导联B组累及比例显著高于A组。心电图心肌缺血性改变中除V1导联以外T波改变的发生率最高,其次为ST段压低,ST段抬高及异常Q波居后。2组心房颤动、束支阻滞、一度房室阻滞、窦性心动过缓发生率差异无统计学意义,A组有27.4%、B组有21.4%的患者心电图未见异常。结论左主干严重狭窄可见于年轻患者,病变越严重心绞痛发生率越高,心电图累及导联越广,Ⅰ、av L、V4~5导联累及比例最高,以T波改变、ST段压低为主,但仍有约1/4患者心电图未见异常。
Objective To analyze the clinical and electrocardiography （ECG） characteristics of the left main coronary artery lesions in different stenosis level, so as to contribute to risk assessment and early diagnosis. Methods A total of 232 patients with left main lesion was collected in our department between January 2008 and December 2014. Accord- ing to coronary angiography examination, the patients were divided into two groups： group A （stenosis degree of 50%- 70%, 73 cases） and group B （stenosis degree≥70%, 154 cases）. The clinical data and electrocardiogram characteristics of the two groups were analyzed. Results The age of Group A ranged from 45 to 79 years old with an average of （61.1± 11.5） years. The age of Group B ranged from 30 to 79 years old with an average of （56.5± 10.4） years. There was significant difference between two groups （P = 0.000）. The incidence of angina in group A was 61.6%, which was lower than that of group B （82.5%, P = 0.001）. There was no significant difference between the two groups in heart attack, hypertension, diabetes and hyper lipidemia. The higher stenosis in left main coronary artery, the more leads were involved, and the involvement leads were Ⅰ, avL, V4-5. Group B had significantly higher involving ratio in lead Ⅰ, avL, V1, V3-6 than group A. The incidence of T-wave changes in cardiogram myocardial ischemic change was the highest, followed by ST segment depression and ST segment elevation and abnormal Q wave. There was no significant difference between the two groups in atrial fibrillation, bundle block, one degree atrioventricular block and sinus bradycardia. And 27.4% patients in group A and 21.4% patients in group B had no abnormal ECG. Conclusion Serious left main stenosis can be seen in young patients. The more stenosis, the higher incidence of severe angina pectoris and the ECG involving lead, especially in lead Ⅰ, avL, V4-5. T wave change and ST-segment depression is most common, however there is still about a quarter of patients with normal ECG.
作者
黄静涵
袁建松
刘圣文
乔树宾
杨跃进
Huang Jinghan;Yuan Jiansong;Liu Shengwen;Qiao Shubin;Yang Yuejin(Cardiopulmonary Function Testing Center, Coronary Heart Disease Center, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences （CAMS） and Peking Union Medical College （PUMC）, Beijing 100037, China)
出处
《北京医学》
CAS
2018年第3期193-196,200,共5页
Beijing Medical Journal
基金
国家自然科学基金(81470204)
北京市自然科学基金(7154232)
关键词
心电图
冠状动脉左主干
狭窄程度
electrocardiogram
left main coronary artery
stenosis degree
