心肌缺血总负荷与冠心病的相关性研究

The relations between total myocardial ischemia burden and coronary heart disease

目的了解心肌缺血总负荷与冠心病的关系,探讨心肌缺血总负荷在评估不同程度、不同支数冠状动脉病变的临床价值。方法120例病人均行冠脉造影及24h动态心电图检查,按冠状动脉造影结果分为两组。一组最少一支冠状动脉完全阻塞;另一组最少一支冠状动脉有不同程度狭窄,但未完全阻塞。通过动态心电图检查计算24h心肌缺血总负荷值、24h心肌缺血总时间、24h心肌缺血发作总次数。结果随冠状动脉狭窄程度加重,心肌缺血总负荷值、心肌缺血总时间、心肌缺血发作总次数增加显著。随冠状动脉病变支数增加,心肌缺血总负荷、缺血时间、缺血次数有进一步增加,但只有三支病变时心肌缺血总负荷值才明显增加。冠状动脉内药物凃层支架术后心肌缺血总负荷值明显下降。结论冠心病患者心肌缺血总负荷增高提示冠状动脉狭窄程度重;若明显增加,反映冠心病病情加重;冠脉内药物凃层支架术是冠心病的最佳治疗;心肌缺血总负荷对判断冠心病病情预后有重要作用。

Objective To investigate the relations between total myocardial ischemia burden and coronary heart disease and to discuss the correlation between total myocardial ischemia burden with different degree of stenosis and different branch of coronary artery disease. Methods All 120 patients had coronary artery radiography and 24-hour Holter examination. They are divided into two groups according to the coronary artery radiography result. In one group at least one coronary artery was completely blocked and in the other group at least one coronary after＇ had stenosis to some extent, but not completely blocked. Calculated 24 hours total load value of myocardial ischemia, 24h total ischenfic time and 24h total number of myocardial ischemic attack in 24- hour Hoher examination. Results （1） Total load value of myocardial ischemia, total time of myocardial ischemia and total number of myocardial ischemia attack increased with the increase in the degree of coronary, artery stenosis. （2） With the increase in the number of coronary artery branch, the total load value of myocardial ischemia, total time of myocardial iscbemia and total number of myocardial ischemia attack further increased. But the total load value of myocardial ischemia was increased only in patients with three coronary artery disease. （3） After drug-eluting stents in coronary artery., the total load value of myocardial ischemia decreased obviously. Conclusions The total myocardial ischemia burden increase with the degree of coronary artery stenosis in pa- tients with coronar3＇ heart disease. A marked increase of the total myocardial ischemia burden reflect the degree of coronary heart disease. Drug-eluting coronary, stent is the best treatment for coronary heart disease. The total myocardial ischemia burden in patients with coronary heart disease can predict their prognosis.