急性下壁心肌梗死并发泵衰竭的临床特征和冠状动脉造影特点分析

Coronary artery angiography and clinical features of acute inferior wall myocardial infarction with pump failure

目的探讨急性下壁心肌梗死并发泵衰竭的临床特征和冠状动脉解削、病变特点。方法选择2002年1月。2007年4月住院治疗的急性下壁心肌梗死并发泵衰竭患者（泵衰竭组）28例和不合并泵衰竭患者（对照组）60例，对其临床资料和冠状动脉造影资料进行回顾性分析。结果泵衰竭组平均年龄高于对照组（P〈0．05），经典冠心病危险因素≥2个者多于对照组（P〈0．05），稳定型心绞痛病史、梗死后心绞痛、合并后壁梗死发生率高于对照组（P〈0．05），肌酸激酶同工酶MB峰值高于对照组（P〈0．05），快速心律失常、胸前导联ST段压低发生率高于对照组（P〈0．05），住院时间和院内病死率高于对照组（P〈0．05），冠状动脉造影显示右冠状动脉超优势分布、合并前降支狭窄〉75％病变、右向左侧支循环建立高于对照组（P〈0．05）。结论急性下壁心肌梗死并发泵衰竭有一定的易患因素和临床特征，早期成功恢复心肌再灌注是治疗的关键。

Objective To investigate the clinical features and coronary artery angiography of acute inferior wall myocardial infarction（AIMI） with pump failure. Methods Twenty-eigh1 AIMI inpatients with pump failure （pump failure group ）between January 2002 and April 2007 were included. Sixty cages without pump failure were included as control group. The clinical datum and coronary arlery angiograms were analyzed retrospectively. Results The pump failure group had elderly ages （P 〈 0.05）,more typical risk factors of coronary artery disease （P 〈 0.05 ）. The incidences of stable precordial angina, post infarction precordial angina, posterior wall myocardial infarction were higher than those in control group （P 〈 0.05 ）. The level of peak CK-MB was higher than that in control group. The pump failure group had longer hospital days and higher mortality （P 〈 0.05）. The coronary artery angiography revealed the higher incidence of right coronary artery overdominance, anterior descending branch 〉 75% lesions, right to left collateral circulation compared with control group（P〈 0.05）. Conclusions AIMI with pump failure often has some special clin- ical features and angiograms. Early and successful revaacularization for reperfusion is the key factor for the treatment.