类似左主干损伤心电图表现的急性胸痛患者的临床特征分析

Clinical characteristics of acute chest pain patients which have electrocardiographic manifestations of left main artery injury

目的总结和探讨类似左主干损伤心电图表现的急性胸痛患者的临床特点、鉴别诊断。方法总结我科近3年诊治的98例急性胸痛入院患者的临床资料,该类患者均具有典型左主干损伤心电图表现,并均经主、肺动脉、冠状动脉CTA或冠脉、主、肺动脉造影检查确诊,研究不同疾病胸痛的临床特征及鉴别诊断方法。结果急性主动脉综合征患者平均发病年龄56岁,胸痛更加严重、常伴有背痛,既往无类似胸痛发作病史,缺乏典型缺血性胸痛心电图及心肌损伤坏死标志物的动态改变,急性冠脉综合征患者具有更多的心血管急性危险因素(≥2),发病年龄平均74岁,既往多有类似发作病史,具有典型缺血性胸痛心电图及心肌损伤坏死标志物水平的动态改变,急性肺动脉栓塞患者以低血压及呼吸困难为主要表现,具有更多肺动脉栓塞危险因素,心电图及心肌损伤坏死标志物缺乏典型动态改变。结论急性胸痛患者如出现类似左主干损伤的心电图表现时,需要考虑到急性主动脉综合征、急性肺动脉栓塞及急性冠脉综合征等高危胸痛可能。患者心血管疾病危险因素、劳力性缺血性胸痛病史、心电图及心肌酶的动态改变有助于尽快明确诊断及尽早采取正确的治疗策略。

Objective To summarize and discuss the clinical characteristics of acute chest pain patients which have electrocardiographic manifestations of left main artery injury. Methods Summarize the clinical datas of 98 patients,which have typical ECG manifestations of left main coronary artery injury,All were diagnosed by aortic CTA,pulmonary artery CTA,coronary artery CTA or by aortic angiography,pulmonary angiography,coronary angiography. Research the clinical features and differential diagnosis of chest pain in different group. Results The average age of acute aortic syndrome group is 56 years,chest pain is more serious,often accompanied by back pain,no chest pain history,Lack dynamic changes of ECG and lack dynamic changes of markers of myocardial injury,The acute coronary syndrome group（ACS） have more cardiovascular risk factors（≥2）,with an average age of 74 years,history of similar attacks and dynamic changes of ECG and myocardial injury markers. In acute pulmonary embolism group（PE）,hypotension and dyspnea are the main manifestations,which have more risk factors for pulmonary embolism,and lack of typical dynamic changes of ECG,lack dynamic changes of markers of myocardial injury. Conclusion Acute chest pain accompany by electrocardiogram changs similar to the left main injury,high risk chest pain,such as acute aortic syndrome,acute pulmonary embolism,and acute coronary syndrome should be considered. The risk factors of cardiovascular disease,the history of exertional ischemic chest pain,electrocardiogram and the dynamic changes of myocardial enzymes are helpful to make a definite diagnosis as soon as possible and take the correct treatment strategy as soon as possible.