慢性心肌缺血中侧支循环作用的研究

Study of collateral circulation in coronary artery disease with chronic occlusive multivessel lesion

目的:运用冠脉造影和非介入性方法研究冠状动脉慢性闭塞多支病变(Chronic Occlusive Multivessle Disease)中侧支循环与临床状况及表示侧支循环状况的临床指标。方法:选择既往无心肌梗塞、有稳定型和不稳定型心绞痛病史,冠脉造影示至少一支冠脉完全闭塞并有多支病变的病人,根据CAG判断侧支循环的分级情况,病人被分为侧支良好组(A组:侧支循环2．3级)和侧支不良组(B组:侧支循环0,1级),对两组患者临床特征进行对比分析。结果:40例冠脉慢性闭塞多支病变患者中侧支良好的有28例(A组),侧支不良的有12例(B组)。心绞痛病程(>3个月)在A组中占96．4％,在B组中占66．6％,B组明显少于A组(P<0．05)。异常Q波的出现率两组分别为28．5％(A组),66．6％(B组),B组明显高于A组(P<0．05)。室壁运动正常者A组占39．2％,明显高于B组的10％(P<0．01)。左室射血分数(LVEF)A组明显高于B组(50±8．0:44．8±5．5,P<0．05)。结论:病程较短,有异常Q波,室壁运动异常,左室射血分数<50％者提示侧支循环不佳。

Objective： To study the relations between collateral circulation （CC） and clinical situation as well as the index indicated collateral circulation by means of coronary angiography （CAG） in coronary artery disease with chronic occlusive multivessel lesion. Methods： The study consisted of 40 patients with chronic coronary occlusion with coro- nary multivessel disease. All patients remained free from myocardial infarction. The patients were divided into group A and group B [with and without the obvious collateral vascular （grade 2, 3）]. Results.. Rate of duration of angina （〉3 months） was significantly higher in group A, than that in group B （P〈0.05）. Abnormal Q waves was less in group A than that in group B （28.5% ： 66. 6%）, P〈0. 05. Abnormal wall motion was significantly less in group A than that in group B （P〈0.01）. LVEF increased in group A than that in group B （50. 0±8.0 ： 44.8±5.5. P〈 0.05 ）. Conclusion： Indexes indicated collateral circulation insufficiency are duration of anginal3 months, abnormal Q waves, abnormal wall motion, LVEF〈50%.