肺心病并发冠心病68例临床分析

Clinical Analysis on the Features of Pulmonary Heart Disease Combined with Coronary Heart Disease

目的：探讨肺心病并发冠心病的临床特点．方法：对2000-01～2007-01在通辽市科尔沁区第一人民医院心内科住院确诊的68例肺心病并发冠心病患者。进行临床表现、心电图、X线胸片、超声心动图等分析．结果：肺心病并发冠心病缺乏典型心绞痛，心电图检查出现左胸导联S-T段压低或冠状T波及V1-3导联QS波者19例（27．9％）；21例患者做了24小时动态心电图11例（52．3％）有发作性心肌缺血改变；X线胸片左心室增大12例及双室扩大6例均伴有主动脉迂曲、延长、钙化（26．5％）；超声心动图左室前壁运动幅度减弱26例（38．2％）．8例行冠状动脉造影，发现右冠状动脉阻塞．结论：肺心病合并冠心病的临床症状不典型，诊断较为复杂，不能套用冠心病的诊断标准，必须结合病史、冠心病的危险因素、临床表现。心电图、24小时动态心电图、心脏超声、X线胸片、心肌酶谱、冠脉造影等综合分析做出诊断．

Objective： To study the dinical features of pulmonary heart disease combined with coronary heart disease. Methods： 68 cases of this disease diagnosed in our hospital from January 2000 to January 2007 were analyzed through its clinical manifestations. ECG, x - ray thoracic film and UCG. Results：This disease was free of typical angina pectoris. 19 cases（27.9% ） manifested lowered S - T segment and coronary T wave in ECG on left thoracic leads, and QS wave on v13 lead. The changes of transient myocardial ischemia in ECG were found in 11 cases out of 21 cases （52.3%）who were monitored with 24- hour dynamic ECG, left ventricular enlargement was shown in x - ray thoracic film for 12 cases and two ventricular enlargements shown combined with the tortuous, prolonged and calcified aorta for 6 cases （total 26.5 % ）. Attenuated movement of anterior wall of left ventricle was shown in UCG for 26 cases （38.2%） .8 cases of right coronary artery obstruction were found through coronary arteriography. Conclusion：The clinical symptoms of this disease are not typical and it can＇t be easily diagnosed through diagnostic standard for coronary heart disease. Its diagnosis should rely on medical history, risk factors of coronary heart disease, clinical manifestations, ECG, 24 - hour dynamic ECG, UCG, x - ray thoracic film, myocardial zymogram and coronary arteriography.