右冠状动脉与左回旋支闭塞心肌梗死患者的临床对比分析

Comparative study of the right coronary artery and left circumflex artery occlusion

目的:对比分析右冠状动脉(RCA)与左回旋支(LCX)闭塞的急性下壁心肌梗死患者的心电图特征、心功能和预后。方法:90例首次急性下壁心肌梗死患者,进行常规心电图及冠状动脉造影。RCA闭塞组(RCA组)63例,LCX闭塞组(LCX组)27例,所有患者均在发病24 h内行直接冠状动脉介入术。术后2周行99mTc-MI-BI心肌灌注断层显像测定心肌梗死面积,并行心血池显像测定左室射血分数(LVEF)。观察住院期间心律失常、心力衰竭或心源性休克的发生率及病死率。结果:①RCA组下壁并右室梗死的发生率显著高于LCX组(P<0.01),而并发侧壁梗死的发生率显著低于LCX组(P<0.01)。②RCA组Ⅲst↑>Ⅱst↑及aVL st↓>Ⅰst↓的发生率也显著高于LCX组(P<0.01)。③RCA组肌酸激酶同工酶峰值及心肌梗死面积均大于LCX组(P<0.05)。④RCA组LVEF低于LCX组(P<0.05)。结论:RCA闭塞较LCX闭塞的急性下壁心肌梗死患者心肌梗死面积大,心功能和预后差。

Objective： To analyse the electrocardiography （ECG） characteristic, heart function, and prognosis of acute inferior infarction cuased by occlusion of right coronary artery（RCA） or left circumflex artery（LCX）. Method： Ninety patients with first acute inferior infarction confirmed by coronary angiography （CAG） were divided into two groups; RCA occlusion group （ n=63） ,LCX occlusion group （ n=27）. All patients underwent direct percutaneous coronary intervention （PCI） within 24 h after onset of AML^99gm Tc-MIBI SPECT was performed to detect myocardial infarction area and ^99mTc gated cardiac blood pool image was performed to detect left ventricular ejection fraction （LVEF） at 2 weeks after PCI. The incidence of arrhythmia,heart failure,cardiogenic shock and mortality was observed. Result： ①The incidence of inferior infarction combined with right ventricular infarction was significantly higher and the incidence of inferior infarction combined with lateral infarction was lower in RCA group than that in LCX group（P〈0.01）. ② The incidence of Ⅲst↑〉Ⅱst↑and aVLst↓〉Ⅰst↓ was significantly higher in RCA group than that in LCX group（ P 〈0.01）.③The peak creatine MB fraction was higher and myocardial infarction area was larger in group RCA than those in group I.CX（ P 〈0.05）. ④LVEF was lower in RCA group than that in I.CX group（ P〈0.05）. ⑤There was a trend of higher incidence of arrhythmia,heart failure, cardiogenic shock and mortality in group RCA compared with that in group LCX. Conclusion： Myocardial infarction area was larger and heart function and prognosis were poorer in RCA occlusion than those in LCX occlusion.