变异型心绞痛发作时的特点分析及预后

Prognosis and analysis of the characteristics of angina attack in patients with variant angina pectoris

目的分析变异型心绞痛(VAP)发作时的特点,探讨其临床意义及预后。方法采用模拟胸导CM5、CM3、CM1记录24h动态心电信息。通过回放记录:①VAP发作时的ST段抬高的时期和持续时间;②VAP发作时ST段抬高部位及ST段最高升幅和抬高极期时的心率;③VAP发作时出现的心律失常及时期;④VAP发作前1h及发作后1h的心率变异性.结果8例VAP患者共发作26例次ST段显著抬高。VAP发作多在22∶00～8∶00,每次持续时间平均(3.5±2.5)min;ST段抬高最显著部位3例在CM5,5例在CM3,反复发作患者ST段改变各自几乎在同一部位;ST段最高升幅平均(8.1±3.7)mm,心率平均(83±20)/min。8例患者有5例伴发心律失常;26例次有13次出现心律失常,其中室早、室速为42%,多数发生在闭塞期;2次室速在再灌注期,1例并院外猝死。发作时1h心率变异性SDNN、SDANN较发作前1h有显著增高(P<0.05)。7例随访4个月至5年无心脏事件发生。结论VAP发作几乎都在后半夜至清晨,冠状动脉痉挛易在各自的部位反复出现,历时短暂,不伴有缺血加重现象;VAP发作时室性心律失常发生率高,可能与大的冠脉痉挛有关,再灌注期并发的高危性室速易致猝死;VAP发作时交感神经兴奋性增高;VAP患者经及时有效治疗预后良好。

Objective The aim is to assess the characteristics of angina attack and prognosis in patients with variant angina pectoris(VAP).Methods 8 patients with VAP were investigated by Holter monitoring,to record and analyze ST segment elevation (coronary spasm) associated occurred period, and continuous times, ST segment elevation sites(CM5,CM3,CM1) and maximal levels, heart rate,arrthymias and heart rate variability in an hour of before and angina attacks. Results There were 26 times of the ST segment elevation in 8 patients with VAP. Most clustered 22∶00-8∶00,averagely lasted (3.5±2.5) min, maximal levels was (8.1±3.7) mm, 3 patients in CM5,5 patients in CM3.The ST segment elevation onset repeatedly at the same location respectively in 5 patients.Heart rate was( 83±20) / min.The incidence of arrhythmia was 63% in the 8 VAP patients, 50% in 26 times.The ventricular arrhythmia was 42%,most of in the spasm period.2 ventricular tachycardia occured in the reperfusion period and 1 patient sudden death. The SDNN,SDANN was markedly highter than the an hour of before attacks (P<0.05=. Other 7 patients follow-up 5 years to 4 months no cardiac events occured. Conclusions The attacks of variant angina tend to be clustered between midnight and 8∶00,coronary artery spasm onset most at the same location,respectively. The incidences of ventricular arrhythmia was highter,associated with coronary spasm sites.During reperfusion, life-threatening ventricular arrhythmias may occur. When VAP occurred the sympathelic nerve activity was highter. By treatment with calcium antagonists and nitrates in time, the prognosis is good.However,the patients with initial variant angina should be treated promptly in order to prevent cardia events.