老年人冠状动脉扩张症的临床特点

The clinic characteristics of elderly patients with coronary ectasia

目的探讨老年人冠状动脉扩张症的临床特点及治疗方法。方法对我院近10年经冠状动脉造影诊断的154例老年冠状动脉扩张症患者的症状、体征、诊断及治疗方法进行总结分析。结果154例冠状动脉扩张症患者均由冠状动脉造影确诊,表现为心绞痛者112例(72.7%),心电图、胸片、超声心动图均无特异性。3例急性心肌梗死患者行急诊溶栓,154例患者均给予肠溶阿斯匹林或肝素抗凝治疗,同时使用硝酸脂类及钙离子拮抗剂扩张血管。154例随访1～20年,出现急性心肌梗死6例,其中再梗死1例,猝死1例;发生急性左心功能衰竭2例。结论心绞痛为老年人冠状动脉扩张症的主要临床表现,冠状动脉造影是确诊的主要方法。本病一旦确诊应长期使用抗凝剂和血管扩张药物,防止冠状动脉痉挛与心肌梗死的发生。急性心肌梗死应积极溶栓,药物治疗不满意者,应行冠状动脉旁路移植术。

Objective To investigate the clinic characteristics and treatment methods of coronary ectasia. Methods One hundred and fifty-four cases in Anzhen hospital during the last 10 years, whom with coronary aneurysm diagnosed by coronary artery angiogram and summarized the characteristics of symptom, sign, diagnosis and treatment. Results All patients were proved with coronary angiography. There were 112(72.7%)patients presenting angina, but with no specific manifestation in electrocardiogram, X-ray and echocardiogram.Thrombolysis in emergency were taken to 3 cases with acute myocardial infarction patients. One hundred and fifty-four cases were treated with aspirin or heparinizeation, and with nitroglycerin, Calcium channel blocker to dilate vessel. The followed up of 154 cases about 1-20 years, six cases were suffered with acute myocardial infarction. One of the 6 cases was reinfarction and one case was sudden death. Conclusions Angina is the main clinical manifestation and coronary angiography is the accurate diagnostic method. Long-term application with anticoagulant agent and vasodilator should be done to prevent coronary spasm and myocardial infarction. If acute myocardial infarction occurs, prompt thrombolysis should be used, if it is ineffective, coronary artery bypass grafting should be carried out.