65例心肌桥临床与心电图特点分析

Clinical and electrocardiography features of myocardial bridge in 65 patients

目的探讨心肌桥临床与心电图特点。方法采用Noble分级方法，对65例冠状动脉造影确诊的心肌桥患者进行临床与心电图特点分析。结果本组心肌桥多位于前降支中远段；Noble分级I级狭窄者31例，Ⅱ～Ⅲ级狭窄者34例；静息心电图呈ST—T改变或T波改变35例（53．85％），Noble分级Ⅱ～Ⅲ级狭窄者心电图异常率（76．5％）高于I级狭窄者（29．0％），差异有统计学意义（P〈O．05）；30例心电图正常者，24h动态心电图显示11例呈间歇性T波改变或ST—T改变，3例发作性ST—T抬高；5例运动平板试验阳性，4例可疑阳性。结论心肌桥多发生在前降支中远段，心电图ST—T改变与心肌桥壁冠状动脉血管狭窄程度有关；动态心电图及运动平板试验可提高心电图诊断的阳性率。

Objective To explore the clinical and electrocardiography features of myocardial bridge. Methods The clinical and electrocardiography features of myocardial bridge were analyzed by Noble class in 65 patients diagnosed on the basis of coronary angiography. Results Myocardial bridge was commonly located on cosco section of the anterior descending branch. By Noble class, 31 cases were in level Ⅰ, and 34 cases were in level Ⅱ to Ⅲ. Resting electrocardiogram showed ST and/or T wave changed in 35 cases （53. 85%）. The positive rate was 74.28% in patients with level U to IH of Noble class, significantly higher than that in patients with level I of Noble class （25.71%）（P〈0.05）. In 30 patients with normal electrocardiography, 24-hour dynamic electrocardiogram inspection revealed 11 cases of intermittent T wave change or ST-T change, 3 cases of paroxysmal ST-T change, 5 cases were positive during athletic flat test, and 4 cases were suspected positive. Conclusions Myocardial bridge commonly occurs on eosco section of the anterior descending branch. ST-T change is correlated with stenosis degree of coronary artery. Dynamic electrocardiography and athletic flat test could increase the electrocardiography diagnosistic rate.