闭塞性冠状动脉病变侧支循环形成的影响因素及其临床意义

Influential Factors for Formation of Collateral Circulation and Their Clinical Significance in the Patients With Sub-Total or Complete Stenosis of Coronary Artery

目的 :探讨闭塞性冠状动脉 (冠脉 )病变侧支循环形成的影响因素及其临床意义。 方法 :冠脉造影证实 1～ 2支冠脉亚闭塞或完全闭塞病人共 68例 ,根据侧支循环情况将其分为A组 (3 1例 ,侧支循环 0～ 1级 )和B组 (3 7例 ,侧支循环 2～ 3级 ) ,对 2组病人部分临床资料进行对比分析。 结果 :A组病人中吸烟史、心肌梗死及糖尿病史、室壁运动异常者及室壁瘤形成率、ST段降低 (∑ST)者及平均心率均高于B组 ,有显著性差异 (P <0 0 5～ 0 0 1) ;而A组病人中原发性高血压史、心绞痛史、定期使用肝素和长期用 β受体阻滞剂者及左心室射血分数 (LVEF)却低于B组 ,有显著性差异 (P <0 0 5～ 0 0 1)。 结论 :①吸烟及糖尿病对侧支循环的形成不利 ,应强调戒烟及控制血糖的重要性 ;②肝素有利于侧支血管形成 ,对于不能介入或冠状动脉旁路移植术治疗的病人尤为必要 ;③心率慢可能促进侧支循环形成 ,故提倡使用 β受体阻滞剂。

Objective:To investigate the influential factors for formation of collateral circulation and their clinical significance in the patients with sub total or complete stenosis of coronary artery. Methods:Sixty eight patients undergoing coronary angiography with one to two sub total or complete stenosis of coronary arteries were divided into two groups according to their collateral circulation. Group A(n=31) had 0 1 grade of collateral circulation. Group B(n=37) had 2 3 grades of collateral circulation. Clinical data were compared between groups. Results:Compaired with group B, the proportions of smokers, and patients with diabetes, myocardial infarction, abnormal motion of ventricular walls and ventricular aneurysm were higher(p<0 05 0 01) in group A. ∑ST(total sum of ST depression of 12 leads) and average heart rate were also higher(p<0 05 0 01).The proportions of patients with hypertension, angina pectoris, and those taking regular heparin or long term receptor blockers, were lower(p<0 05 0 01). The left ventricular ejection fraction(LVEF) was also lower(p<0 05). Conclusions:①Smoking and high blood glucose are unfavourable to the formation of collateral circulation, so it is necessary to stop smoking and control diabetes;②The use of heparin is beneficial to the formation of collateral circulation. We suggest that the patients with coronary artery disease use heparin regularly, especially for those who are not indiated for interventional treatment or coronary artery bypass grafting(CABG);③Decreasing heart rate may promote the formation of collateral circulation. We recommend that the patients should use long term receptor blockers.