以腹痛为特征的冠心病47例临床分析

Clinical Analysis of 47 Cases With Abdominal Pain Type of Coronary Heart Disease

冠心病（ＣＨＤ）以非典型形式出现者近年来在临床上越来越受到重视．本文对４７例以腹痛为特征的ＣＨＤ进行观察分析，发现有以下特征：①老年人为多．本组６０岁以上者占７６．７％，这与老年人并有脑动脉硬化，痛觉迟钝，神经传导功能减退有关；②女生高于男性。本文男女之比为１：２，提示可能与性激素变化有关；③ＣＨＤ不管是心肌梗塞还是心肌缺血，都可表现为腹痛型，这说明ＣＨＤ各阶段都可以不典型形式出现；④腹痛型ＣＨＤ患者其心肌病变大都在心脏后下壁。腹痛原因可能与放射痛及病变部位刺激迷走反射有关；⑤治疗应以扩管、抗凝、营养心肌等为主，部分患者辅以调节胃肠功能的药物，可减少心外刺激，加强疗效。

Clinicians pay increasingly attention to the atypical forms of coronary heart diease (CHD)in the recent yesrs. The present clinical study observed 47CHD patients with abdominal pain. The results showed that: 1. More common in elderly patients,which may be associated with the cerebra arteriosclenosis,hypoalgesia and function reduction of nerve conduction; 2. More common in female patients. The ratio is two to one (2: 1 )between female and male,which may be related to the change of sex hormone; 3. The symptom of abdominal pain can be observed not only in the patients of myocardial infarction, but also in the patients of myocardial ischemic , which indicates that the atypical clinical form may be seen in the all phases of CHD; 4. The myocardial pathological changes occured mainly on the posterior and lower wall of the heart in these patients and the causes of abdominal pain may be related to radialipain and vagus relax stimulated by sick site ; 5. In the treatment, the priniciple is on the basis of dilating vesselse , resisting coagutation and nurishying myocardium and on the completment of abjusting gastrointestinal function in some patients,which can improve the treating effect significantly.