梗死后心绞痛临床类型及与血管病变的关系

The relationship between clinical types of postinfarction angina and stenosis of ischemia-related artery

目的 探讨梗死后心绞痛的发病机制 ,为指导临床治疗提供依据。方法 收集自 1995年 1月至 1999年 6月间住院的急性心肌梗死并发梗死后心绞痛的患者 6 7例 ,分析其临床发作特点及与缺血相关狭窄病变的关系。结果 (1)以心绞痛发作性质进行分类 ,梗死后自发型心绞痛最常见(4 3 9% )、梗死后混合型心绞痛次之 (2 5 7% )、梗死后劳力型心绞痛 (16 7% )和梗死后变异型心绞痛(13 6 % )相对少见。 (2 )缺血相关血管狭窄≥ 90 %在梗死后混合型、自发型、劳力型和变异型心绞痛所占比例分别为 10 0 %、82 8%、72 7%和 44 4%。 (3)由非梗死相关血管所致的心绞痛在梗死后心绞痛中所占比例甚少 (8 9% )。结论 梗死相关血管的严重残余狭窄是梗死后心绞痛的主要病理因素 ,而冠状动脉收缩或痉挛以及短暂心肌耗氧量增加等因素均可作为诱发因素 ,应尽早行介入或外科手术治疗。

Objective To approach the pathogenesis of postinfarction angina and set up its treatment guidelines. Methods 67 patients with postinfarction angina undergoing coronary angiography during the hospitalization were studied. Results (1)According to the clinical classification of angina pectoris, spontaneous angina is the most common type (43.9%); mixed angina is second (25.7%), effort angina and variant angina are ralatively low frequency (16.7% & 13.6%). (2) Stenosis ≥90% in the ischemia related artery accounted for the anginal symptoms constituted 100%, 82.8%, 72.7% and 44.4% of the cases with mixed angina, spontaneous angina, effort angina and variant angina respectively. (3) Postinfarction angina caused by non infarction related artery was relatively less frequent (8.9%). Conclusions Severe residual stenosis of infarction related artery is the main pathologic factor on the pathogenesis of postinfarction angina, so early interventional therapy or bypass surgery should be taken.