变异型心绞痛12例临床分析

Variant Angina:Clinical Analysis of 12 Cases

目的:分析变异型心绞痛的临床特点及治疗方法。方法:根据在静息状态下发生心绞痛,床旁12导联体表心电图或动态心电图监测证实心绞痛发作时ST段抬高,胸痛缓解后ST段恢复至基线,有12例患者确诊为变异型心绞痛。分别从性别、年龄、临床表现、冠心病危险因素、辅助检查及治疗进行分析。结果:该病好发于男性(占91．7％),发病时平均年龄为56岁,除吸烟外,多无其他的冠心病危险因素,心绞痛多于凌晨静息时发作,含服硝酸酯类药物有效,5例(占41．6％)发病时并发室性心动过速及高度房室传导阻滞恶性心律失常,8例(占83％)冠状动脉有固定性狭窄,硝酸酯类药物与钙通道阻滞剂可有效防止复发,支架植入有效。结论:静息状态下特别是清晨时发生胸痛的患者,胸痛时应及时行心电图检查以诊断或排除变异型心绞痛,变异型心绞痛恶性心律失常发生率高,需及时诊断治疗,硝酸酯类药物多可缓解症状,硝酸酯类药物与钙通道阻滞剂可有效防止复发,较高比例的患者有冠状动脉严重的固定性狭窄,变异型心绞痛患者均应行冠脉造影术检查,对有严重狭窄者可行支架植入以有效地治疗心绞痛。

Objective：To study the clinical manifestation and treatment of variant angina. Methods：Twelve patients were diagnosed as variant angina, depending on ST segment elevation of 12 leads electrocardiograph （ECG） while having chest pain at rest, and ST segment return to baseline. Their clinical data were analysed. Results： The disease affects men more frequently than women （11：1）, the average age of patients was 56 years old, they lacked classic risk factors for coronary artery disease except smoking. Chest pain usually occurred in early morning, and responded well to sublingual nitroglycerin, 5 patients suffered from serious arrhythmia including ventricular tachyarrhythmia and high grade AV block during chest pain. Significant fixed coronary obstruction occurred in 8 patients （83 %）. Nitrates and calcium antagonists were extremely effective in preventing variant angina. Placement of stents in the coronary arteries with severe fixed obstruction was helpful. Conclusion： ECG should be taken immediately in the patients with angina at rest to confirm or rule out the diagnosis. Variant angina is usually accompamecl by serious arrhythmia. Nitrates and calcium antagonists is extremely effective in preventing variant angina. Placement of stents in the coronary arteries with severe fixed obstruction is helpful.