左冠状动脉主干狭窄的临床分析

Clinical Analysis of Left Main Coronary Artery Disease

目的：探讨左冠状动脉主干（左主干）狭窄患者的临床特征、诊断方法、治疗和预后。方法：据冠状动脉造影（冠造）确定左主干管径狭窄≥５０％为临床有意义病变。并据左主干合并其它血管病变的支数分为：单纯左主干组１３例（１１．３％）；左主干并单支组８例（６．９％）；左主干并双支组２１例（１８．３％）；左主干并三支组７３例（６３．５％）。结果：①１４０９例确诊为冠心病的患者中左主干狭窄１１５例，占８．２％。冠造显示左主干Ⅰ级病变多，占５０．４％；Ⅳ级病变少，占３．５％。②８１例（７０．４％）患者临床表示为不稳定型心绞痛，６９例（６０．０％）患者有心肌梗死病史，５３例（４６．１％）患者胸痛发作时心电图ＳＴ段下移≥０．２ｍＶ，１６例（１３．９％）做运动试验者伴ＳＴ段下移≥０．２ｍＶ。单纯左主干组患者年龄轻（Ｐ＜０．０５），心肌梗死发生率低（Ｐ＜０．０５），左心室射血分数高（Ｐ＜０．０５）。７７例（６６．９％）行冠状动脉旁路移植术，术后６５例（８４．４％）心绞痛消失，手术死亡率为１０．３％。１例左主干开口狭窄９０．０％的患者于造影后猝死。３７例未手术者中４例在随访期死亡，死亡率为１０．８％。结论：左主干狭窄患者心绞痛严重，多合并?

? Objective:To approach the clinical features,diagnosis,treatment and prognosis of patients with left main coronary artery(LM)disease Methods:Significant stenosis was defined as≥50% reduction of LM diameter by coronary angiographyThere were 115 cases with LM stenosis,among them,isolated LM stenosis in 13(113%),LM with onevessel stenosis in 8(69%),LM with twovessel stenosis in 21(183%)and LM with threevessel stenosis in 73(635%) Results:①There were 115 cases with LM stenosis in 1 409 patients with coronary artery disease,the incidence of LM stenosis was 82%Cornary angiography showed that onegrade lesion of LM accounted for 504%,total occlusion was uncommon 35%②Eightyone(704%) patients had unstable angina pectoris,69(600%) had myocardial infarction historyMarked STsegment depression(≥02 mV) was found in 53(461%)during the episodes of angina and in 16(139%) during exercise testingIn isolated LM stenosis group,the incidence of myocardial infarction was lower(p<005),and the LVEF was higher(p<005) than in LM with other vessel stenosis groupAortocoronary bypass surgery was performed in 77(669%)patients,the severe angina disappeared in 65(844%),and 8(103%) patients diedA sudden death occurred in 1 patient with severe stenosis (900%) of LM after coronary angiographyDuring the period of followup,4(108%) of 37 nonoperative patients died Conclusion:The patients with LM stenosis have severe angina pectoris,most of them are complicated with other vessel lesionsCoronary angiography is the only way for diagnosis and CABG is the best method for treatment