冠心病左主干病变与三支病变的临床及心电图比较分析

Comparative analysis for the clinical manifestation and electrocardiogram between left main coronary artery disease and three-vessel disease

目的 探讨临床表现及常规心电图在判断左主干病变与三支冠状动脉病变患者的价值。方法 收集本院经冠脉造影证实狭窄程度≥ 75 %的左主干或合并左主干病变的患者 14例 ,三支病变患者 30例。所有患者观察静态常规 12导联心电图ST段及T波 ,计算存在异常ST段 T波的导联总数 ,动脉造影观察侧支循环形成情况。结果 左主干组及三支病变组患者的年龄分别为 ( 6 0 .36± 12 .86 )岁及 ( 6 2 .5 7± 7.0 0 )岁 ,高血压的发生率分别为 78.5 7% ( 11 14 )与 6 3.33% ( 19 30 ) ,糖尿病的发生率分别为 2 8.5 7% ( 4 14 )与 2 3.33% ( 7 30 ) ,心肌梗死的发生率为 2 8.5 7% ( 4 14 )与 36 .6 7% ( 11 30 )。 14例左主干病变患者除 1例没有静态心电图异常外 ,其余 13例 ( 92 .86 % )均存在 3～ 11个导联 (平均 5 .71个导联 )的ST T异常 ;30例三支病变患者 2 3例 ( 76 .6 7% )有 2～ 11个导联 (平均 5 .5 0个导联 )的心电图异常。 2组出现侧支循环的例数分别为 5例 ( 35 .71% )和 9例 ( 30 .0 0 % )。所有上述指标经统计学检验都无显著差异。结论 无法从临床及常规静态心电图检查鉴别冠心病患者为左主干病变或三支病变。对典型临床心绞痛症状的患者应尽早行选择性冠状动脉造影术 ,以制订临床治疗方案 。

Objective To investigate the significance of differentiating left main coronary artery disease (LM) from three vessel disease (TV) by clinical manifestation and electrocardiogram (ECG).Methods 44 patients (30 men and 14 women, age range:62.00±9.20 years) were included in the study. There were 14 patients with LM whose degree of stenosis identified by coronary angiography was ≥75%,and there were 30 patients with TV. The resting 12 lead ECG was recorded for all the patients to observe ST segment and T wave. The numbers of leads with abnormal ST segment and T wave were counted and the conditions of collateral circulation were observed by coronary angiography.Results The age ranges of LM group and TV group were(60.36±12.86)and(62.57±7.00)respectively; the incidence of hypertension was 78.57 % (11/14) and 63.33% (19/30) respectively; the incidence of diabetes mellitus was 28.57% (4/14) and 23.33% (7/30) respectively, the incidence of myocardial infarction was 28.57% (4/14) and 36.67% (11/30).There were 13 (92.86%) of 14 patients with LM whose ST T had abnormality (mean number:5.71);there were 23 (76.67%) of 30 patients with TV whose ST T had abnormality (mean number:5.50).The collateral circulations were found in 5 patients (35.71%) of LM group and in 9 patients (30.00% ) of TV group. There was no significant difference in all the parameters between two groups (P>0.05).Conclusion The differentiation of LM patients from TV patients can't be done by clinical symptoms and resting ECG. The selective coronary angiography should be done as early as possible to draw up the therapeutic plan and to evaluate patient's prognosis.